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A Practical Guide to Haemostasis


DOAC Score

Introduction:

The DOAC score is a clinical prediction algorithm for estimating the risk of bleeding in patients with non-valvular Atrial Fibrillation [AF] on a Direct-Acting Oral Anticoagulant [DOAC].



DOAC SCORE


The score was developed using data from RE-LY trail [Randomised Evaluation of Long-Term Anticoagulation Therapy], further developed using data in the GARFIELD-AF registry [Global Anticoagulant Registry in the Field-Atrial Fibrillation] and then validated using the COMBINE-AF trials [A Collaboration Between Multiple Institutions to Better Investigate Non-Vitamin K Antagonist Oral Anticoagulant Use in Atrial Fibrillation] and individuals in the Quebec Régie de l’Assurance Maladie du Québec and Med-Echo Administrative Databases (RAMQ) administrative database.

The DOAC score was developed using data from the RE-LY study and in which patients received Dabigatran 150mg twice daily. The score was then refined using data from the GARFIELD-AF registry with patients on all DOACs - Apixaban, Edoxaban and Rivaroxaban.


Select Criteria:

Age [yr]
65-69 2 Points
70-74 3 Points
75-79 4 Points
≥80 5 Points
Creatinine Clearance/eGFR [mL/min]
30-60 1 Point
<30 2 Points
Underweight [BMI <18.5kg/m2]
1 Point
Stroke/TIA/Embolism History
1 Point
Diabetes
1 Point
Hypertension
1 Point
Antiplatelet use
Aspirin 2 Points
Dual antiplatelet therapy [Aspirin + P2Y12 inhibitor] 3 Points
Non-steroidal anti-inflammatory drugs [NSAIDs]
1 Point
Bleeding History
3 Points
Liver Disease*
2 Points


*Defined as an AST, ALT, ALP ≥3X upper limit of normal, an ALP ≥2X upper limit of normal, or cirrhosis.


Score

Interpretation
DOAC Score 1-Year Major Bleeding Risk
0-3 Very Low
4-5 Low
6-7 Moderate
8-9 High
10 Very High

Individuals with a score of 10 or more are assigned a score of 10.

For additional information on the DOAC score - see references.


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