Saturday, July 16, 2011

The ATRIA Risk Prediction Score - A New Tool to Predict Bleeding Risk from Warfarin in Kidney Patients and Others.

A new 5-variable score, developed by Margaret Fang, MD, MPH, of the University of California San Francisco, and colleagues, outperformed six other published and validated risk scores in predicting the risk of warfarin-associated hemorrhage in patients with atrial fibrillation.


Five independent variables were included in the final model and weighted by regression coefficients: anemia (3 points), severe renal disease (e.g., glomerular filtration rate <30 ml/min or dialysis-dependent, 3 points), age 75 years (2 points), prior bleeding (1 point), and hypertension (1 point). Major hemorrhage rates ranged from 0.4% (0 points) to 17.3% per year (10 points). Collapsed into a 3-category risk score, major hemorrhage rates were 0.8% for low risk (0 to 3 points), 2.6% for intermediate risk (4 points), and 5.8% for high risk (5 to 10 points). The c-index for the continuous risk score was 0.74 and 0.69 for the 3-category score, higher than in the other risk schemes. There was net reclassification improvement versus all 6 comparators (from 27% to 56%).

Ref: Fang M, et al "A new risk scheme to predict warfarin-associated hemorrhage: The ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) study" J Am Coll Cardiol 2011; 58: 395-401.

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