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A risk model predicted major bleeding in older patients with atrial fibrillation receiving warfarin therapy

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 Q In older patients with atrial fibrillation (AF) who are receiving warfarin therapy at hospital discharge, does a contemporary bleeding risk model predict major bleeding?

Clinical impact ratings GP/FP/Primary care ★★★★★★☆ IM/Ambulatory care ★★★★★★☆ Geriatrics ★★★★★★☆ Haematology ★★★★★★☆


Embedded ImageDesign:

2 cohort studies, 1 for derivation and 1 for validation, from the National Registry of Atrial Fibrillation.

Embedded ImageSetting:


Embedded ImagePatients:

26 345 patients ⩾65 years of age (88% >70 y, 43% >80 y, 53% women) (19 875 for derivation; 6470 for validation) with AF who were receiving warfarin therapy at hospital discharge. Exclusion criteria included discharge against medical advice, transfer to another acute care hospital, enrolment in managed care, or death during hospital admission.

Embedded ImageDescription of prediction guide:

the risk score (range 0–4.17) categorised patients into low (score ⩽1.07), moderate (score >1.07 to <2.19), or high risk (score ⩾2.19) groups. Multivariate analysis of risk factors found 8 independent clinical variables that predicted major bleeding events. The risk …

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  • * LR defined in glossary and calculated from data in article.

  • For correspondence: Dr T Shireman, University of Kansas Medical Center, Kansas City, KS, USA. tshireman{at}

  • Source of funding: American Heart Association.