Phetroong et al reported a prediction score for bleeding in a patient on long-term warfarin therapy for heart valve disease. This can help to identify a patient who may require closer monitoring or dose adjustment. The authors are from multiple institutions in Thailand and the University of Liverpool.
The name HEARTS-60+3 is based on the score components.
Patient selection: adult on long-term warfarin therapy for either (1) mitral valve stenosis with atrial fibrillation or (2) mechanical heart valve
Predictors:
(1) hypertension
(2) hepatic insufficiency (cirrhosis, advanced hepatitis)
(3) alcohol consumption
(4) aspirin
(5) NSAIDs
(6) anemia (< 13 g/dL for male or < 12 g/dL for female)
(7) hypoalbuminemia (serum albumin < 3.5 g/dL
(8) renal insufficiency (creatinine clearance < 30 mL/min)
(9) time in therapeutic range less than 60%
(10) stroke or TIA history
(11) bleeding history
(12) age in years (>= 60 years)
(13) INR (> 3.0)
total score =
= SUM(number of predictors present)
Interpretation:
• minumum score: 0
• maximum score: 13
|
Total Score
|
Risk Group
|
Events per 100 Year Patient Years
|
|
0 to 2
|
low
|
1.01
|
|
3
|
moderate
|
6.6
|
|
>= 4
|
high
|
19.6
|
from Table 4 (differs from data in Section 3.2)
Performance:
• The area under the ROC curve is 0.84.
