Bleeding Risk and Antithrombotic Strategy in Patients With Sinus Rhythm and Heart Failure With Reduced Ejection Fraction Treated With Warfarin or Aspirin

Siqin Ye, Bin Cheng, Gregory Y H Lip, Richard Buchsbaum, Ralph L Sacco, Bruce Levin, Marco R. Di Tullio, Min Qian, Douglas L. Mann, Patrick M. Pullicino, Ronald S. Freudenberger, John R. Teerlink, J. P. Mohr, Susan Graham, Arthur J. Labovitz, Conrado J. Estol, Dirk J. Lok, Piotr Ponikowski, Stefan D. Anker, John L P Thompson & 1 others Shunichi Homma

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

We sought to assess the performance of existing bleeding risk scores, such as the Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol Concomitantly (HAS-BLED) score or the Outpatient Bleeding Risk Index (OBRI), in patients with heart failure with reduced ejection fraction (HFrEF) in sinus rhythm (SR) treated with warfarin or aspirin. We calculated HAS-BLED and OBRI risk scores for 2,305 patients with HFrEF in SR enrolled in the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction trial. Proportional hazards models were used to test whether each score predicted major bleeding, and comparison of different risk scores was performed using Harell C-statistic and net reclassification improvement index. For the warfarin arm, both scores predicted bleeding risk, with OBRI having significantly greater C-statistic (0.72 vs 0.61; p = 0.03) compared to HAS-BLED, although the net reclassification improvement for comparing OBRI to HAS-BLED was not significant (0.32, 95% confidence interval [CI] -0.18 to 0.37). Performance of the OBRI and HAS-BLED risk scores was similar for the aspirin arm. For participants with OBRI scores of 0 to 1, warfarin compared with aspirin reduced ischemic stroke (hazard ratio [HR] 0.51, 95% CI 0.26 to 0.98, p = 0.042) without significantly increasing major bleeding (HR 1.24, 95% CI 0.66 to 2.30, p = 0.51). For those with OBRI score of ≥2, there was a trend for reduced ischemic stroke with warfarin compared to aspirin (HR 0.56, 95% CI 0.27 to 1.15, p = 0.12), but major bleeding was increased (HR 4.04, 95% CI 1.99 to 8.22, p

Original languageEnglish (US)
Article number21244
Pages (from-to)904-912
Number of pages9
JournalAmerican Journal of Cardiology
Volume116
Issue number6
DOIs
StatePublished - Sep 15 2015

Fingerprint

Warfarin
Aspirin
Heart Failure
Hemorrhage
Outpatients
Confidence Intervals
Stroke
Renal Hypertension
International Normalized Ratio
Proportional Hazards Models
Alcohols

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Bleeding Risk and Antithrombotic Strategy in Patients With Sinus Rhythm and Heart Failure With Reduced Ejection Fraction Treated With Warfarin or Aspirin. / Ye, Siqin; Cheng, Bin; Lip, Gregory Y H; Buchsbaum, Richard; Sacco, Ralph L; Levin, Bruce; Di Tullio, Marco R.; Qian, Min; Mann, Douglas L.; Pullicino, Patrick M.; Freudenberger, Ronald S.; Teerlink, John R.; Mohr, J. P.; Graham, Susan; Labovitz, Arthur J.; Estol, Conrado J.; Lok, Dirk J.; Ponikowski, Piotr; Anker, Stefan D.; Thompson, John L P; Homma, Shunichi.

In: American Journal of Cardiology, Vol. 116, No. 6, 21244, 15.09.2015, p. 904-912.

Research output: Contribution to journalArticle

Ye, S, Cheng, B, Lip, GYH, Buchsbaum, R, Sacco, RL, Levin, B, Di Tullio, MR, Qian, M, Mann, DL, Pullicino, PM, Freudenberger, RS, Teerlink, JR, Mohr, JP, Graham, S, Labovitz, AJ, Estol, CJ, Lok, DJ, Ponikowski, P, Anker, SD, Thompson, JLP & Homma, S 2015, 'Bleeding Risk and Antithrombotic Strategy in Patients With Sinus Rhythm and Heart Failure With Reduced Ejection Fraction Treated With Warfarin or Aspirin', American Journal of Cardiology, vol. 116, no. 6, 21244, pp. 904-912. https://doi.org/10.1016/j.amjcard.2015.06.016
Ye, Siqin ; Cheng, Bin ; Lip, Gregory Y H ; Buchsbaum, Richard ; Sacco, Ralph L ; Levin, Bruce ; Di Tullio, Marco R. ; Qian, Min ; Mann, Douglas L. ; Pullicino, Patrick M. ; Freudenberger, Ronald S. ; Teerlink, John R. ; Mohr, J. P. ; Graham, Susan ; Labovitz, Arthur J. ; Estol, Conrado J. ; Lok, Dirk J. ; Ponikowski, Piotr ; Anker, Stefan D. ; Thompson, John L P ; Homma, Shunichi. / Bleeding Risk and Antithrombotic Strategy in Patients With Sinus Rhythm and Heart Failure With Reduced Ejection Fraction Treated With Warfarin or Aspirin. In: American Journal of Cardiology. 2015 ; Vol. 116, No. 6. pp. 904-912.
@article{cfd3f7414f134113981ca3780a312234,
title = "Bleeding Risk and Antithrombotic Strategy in Patients With Sinus Rhythm and Heart Failure With Reduced Ejection Fraction Treated With Warfarin or Aspirin",
abstract = "We sought to assess the performance of existing bleeding risk scores, such as the Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol Concomitantly (HAS-BLED) score or the Outpatient Bleeding Risk Index (OBRI), in patients with heart failure with reduced ejection fraction (HFrEF) in sinus rhythm (SR) treated with warfarin or aspirin. We calculated HAS-BLED and OBRI risk scores for 2,305 patients with HFrEF in SR enrolled in the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction trial. Proportional hazards models were used to test whether each score predicted major bleeding, and comparison of different risk scores was performed using Harell C-statistic and net reclassification improvement index. For the warfarin arm, both scores predicted bleeding risk, with OBRI having significantly greater C-statistic (0.72 vs 0.61; p = 0.03) compared to HAS-BLED, although the net reclassification improvement for comparing OBRI to HAS-BLED was not significant (0.32, 95{\%} confidence interval [CI] -0.18 to 0.37). Performance of the OBRI and HAS-BLED risk scores was similar for the aspirin arm. For participants with OBRI scores of 0 to 1, warfarin compared with aspirin reduced ischemic stroke (hazard ratio [HR] 0.51, 95{\%} CI 0.26 to 0.98, p = 0.042) without significantly increasing major bleeding (HR 1.24, 95{\%} CI 0.66 to 2.30, p = 0.51). For those with OBRI score of ≥2, there was a trend for reduced ischemic stroke with warfarin compared to aspirin (HR 0.56, 95{\%} CI 0.27 to 1.15, p = 0.12), but major bleeding was increased (HR 4.04, 95{\%} CI 1.99 to 8.22, p",
author = "Siqin Ye and Bin Cheng and Lip, {Gregory Y H} and Richard Buchsbaum and Sacco, {Ralph L} and Bruce Levin and {Di Tullio}, {Marco R.} and Min Qian and Mann, {Douglas L.} and Pullicino, {Patrick M.} and Freudenberger, {Ronald S.} and Teerlink, {John R.} and Mohr, {J. P.} and Susan Graham and Labovitz, {Arthur J.} and Estol, {Conrado J.} and Lok, {Dirk J.} and Piotr Ponikowski and Anker, {Stefan D.} and Thompson, {John L P} and Shunichi Homma",
year = "2015",
month = "9",
day = "15",
doi = "10.1016/j.amjcard.2015.06.016",
language = "English (US)",
volume = "116",
pages = "904--912",
journal = "American Journal of Cardiology",
issn = "0002-9149",
publisher = "Elsevier Inc.",
number = "6",

}

TY - JOUR

T1 - Bleeding Risk and Antithrombotic Strategy in Patients With Sinus Rhythm and Heart Failure With Reduced Ejection Fraction Treated With Warfarin or Aspirin

AU - Ye, Siqin

AU - Cheng, Bin

AU - Lip, Gregory Y H

AU - Buchsbaum, Richard

AU - Sacco, Ralph L

AU - Levin, Bruce

AU - Di Tullio, Marco R.

AU - Qian, Min

AU - Mann, Douglas L.

AU - Pullicino, Patrick M.

AU - Freudenberger, Ronald S.

AU - Teerlink, John R.

AU - Mohr, J. P.

AU - Graham, Susan

AU - Labovitz, Arthur J.

AU - Estol, Conrado J.

AU - Lok, Dirk J.

AU - Ponikowski, Piotr

AU - Anker, Stefan D.

AU - Thompson, John L P

AU - Homma, Shunichi

PY - 2015/9/15

Y1 - 2015/9/15

N2 - We sought to assess the performance of existing bleeding risk scores, such as the Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol Concomitantly (HAS-BLED) score or the Outpatient Bleeding Risk Index (OBRI), in patients with heart failure with reduced ejection fraction (HFrEF) in sinus rhythm (SR) treated with warfarin or aspirin. We calculated HAS-BLED and OBRI risk scores for 2,305 patients with HFrEF in SR enrolled in the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction trial. Proportional hazards models were used to test whether each score predicted major bleeding, and comparison of different risk scores was performed using Harell C-statistic and net reclassification improvement index. For the warfarin arm, both scores predicted bleeding risk, with OBRI having significantly greater C-statistic (0.72 vs 0.61; p = 0.03) compared to HAS-BLED, although the net reclassification improvement for comparing OBRI to HAS-BLED was not significant (0.32, 95% confidence interval [CI] -0.18 to 0.37). Performance of the OBRI and HAS-BLED risk scores was similar for the aspirin arm. For participants with OBRI scores of 0 to 1, warfarin compared with aspirin reduced ischemic stroke (hazard ratio [HR] 0.51, 95% CI 0.26 to 0.98, p = 0.042) without significantly increasing major bleeding (HR 1.24, 95% CI 0.66 to 2.30, p = 0.51). For those with OBRI score of ≥2, there was a trend for reduced ischemic stroke with warfarin compared to aspirin (HR 0.56, 95% CI 0.27 to 1.15, p = 0.12), but major bleeding was increased (HR 4.04, 95% CI 1.99 to 8.22, p

AB - We sought to assess the performance of existing bleeding risk scores, such as the Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol Concomitantly (HAS-BLED) score or the Outpatient Bleeding Risk Index (OBRI), in patients with heart failure with reduced ejection fraction (HFrEF) in sinus rhythm (SR) treated with warfarin or aspirin. We calculated HAS-BLED and OBRI risk scores for 2,305 patients with HFrEF in SR enrolled in the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction trial. Proportional hazards models were used to test whether each score predicted major bleeding, and comparison of different risk scores was performed using Harell C-statistic and net reclassification improvement index. For the warfarin arm, both scores predicted bleeding risk, with OBRI having significantly greater C-statistic (0.72 vs 0.61; p = 0.03) compared to HAS-BLED, although the net reclassification improvement for comparing OBRI to HAS-BLED was not significant (0.32, 95% confidence interval [CI] -0.18 to 0.37). Performance of the OBRI and HAS-BLED risk scores was similar for the aspirin arm. For participants with OBRI scores of 0 to 1, warfarin compared with aspirin reduced ischemic stroke (hazard ratio [HR] 0.51, 95% CI 0.26 to 0.98, p = 0.042) without significantly increasing major bleeding (HR 1.24, 95% CI 0.66 to 2.30, p = 0.51). For those with OBRI score of ≥2, there was a trend for reduced ischemic stroke with warfarin compared to aspirin (HR 0.56, 95% CI 0.27 to 1.15, p = 0.12), but major bleeding was increased (HR 4.04, 95% CI 1.99 to 8.22, p

UR - http://www.scopus.com/inward/record.url?scp=84940542166&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84940542166&partnerID=8YFLogxK

U2 - 10.1016/j.amjcard.2015.06.016

DO - 10.1016/j.amjcard.2015.06.016

M3 - Article

VL - 116

SP - 904

EP - 912

JO - American Journal of Cardiology

JF - American Journal of Cardiology

SN - 0002-9149

IS - 6

M1 - 21244

ER -