Chen et al reported a nomogram for predicting the risk of major bleeding in a patient with atrial fibrillation being treated with a direct oral anticoagulant (DOAC). This is called the Alflafa Major Bleeding (Alfalfa MB) score. The authors are from Fujian Medical University, Chongqing University and affiliated hospitals.
Patient selection: atrial fibrillation, treated with a direct oral anticoagulant (DOAC)
NOTE: The authors also reported the Alfalfa-DOAV-GIB score for major GI bleeding associated with DOAC therapy.
Alfalfa is the name for the research group and represents happiness and luck.
Parameters:
(1) age of the patient in years
(2) history of bleeding
(3) anemia
(4) vascular disease
(5) therapy with antiplatelet therapy or NSAIDs
(6) gastrointestinal protective agents (proton pump inhibitor, other)
(7) therapy rivaroxaban
|
Parameter
|
Finding
|
Points
|
|
age of the patient
|
<= 65 years of age
|
0
|
|
|
> 65 years of age
|
10
|
|
history of bleeding
|
no
|
0
|
|
|
yes
|
7.9
|
|
anemia
|
no
|
0
|
|
|
yes
|
4.8
|
|
vascular disease
|
no
|
0
|
|
|
yes
|
7
|
|
antiplatelet drug or NSAIDs
|
no
|
0
|
|
|
yes
|
8.6
|
|
GI protective agent
|
yes
|
0
|
|
|
no
|
8.6
|
|
ribaroxaban
|
no
|
0
|
|
|
yes
|
4.2
|
where:
• Therapy with a GI protective agent should reduce risk, and therapy with antiplatelet drugs or NSAIDS should raise the risk. The nomogram sows the opposite. The values from Table 2 are followed instead.
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 51.1
value of X =
= (0.1245 * (score)) - 6.349
probability of major bleeding =
= 1 / (1 + EXP((-1) * X))
