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A Practical Guide to Haemostasis


Assessing the Risk of Bleeding in Patients with non-valvular Atrial Fibrillation [AF] Treated with a DOAC [NOAC]:
The ABH Score

Introduction:

The ABH score is a clinical prediction rule for assessing the bleeding risk in patients with Atrial Fibrillation [AF] treated with a DOAC [or NOAC].  In the initial score, 10 variables were analysed - see below. A simplified version of the algorithm was subsequently developed using three variables: Age,  a history of bleeding and non-bleeding related hospitalisation in the preceding 12 months - see ABH Score - Simplified.

Drugs used in the study from which the algorithm was derived were:
  - Apixaban 2.5 mg or 5 mg
  - Rivaroxaban 15 mg or 20 mg
  - Dabigatran 110 mg or 150 mg.
Edoxaban was not approved for stroke prevention in AF at the time of the study.

ABH Score - Original


Select Criteria:

Male Gender
1 Point
Age
<65yrs 0 Points
65-75yrs 1 Point
>75yrs 2 Points
Hypertension
1 Point
Chronic Kidney Disease
1 Point
Chronic Heart Failure
1 Point
Prior Stroke or Transient Ischaemic Attack [TIA]
1 Point
Chronic Obstructive Pulmonary Disease [COPD]
1 Point
Anaemia diagnosed in the preceding 12 months
1 Point
Positive Bleeding History
2 Points
Hospitalisation in the preceding 12 months [Non-bleeding related]
1 Point


Score
[Max Score 12]

Interpretation Bleeding Risk
0-2 points Low Risk
3-4 points Low Intermediate Risk
5-6 points High Intermediate Risk
7-12 points High Risk


Score Risk Category 1 Year Cumulative Bleeding Risk [%]
0 points
1 points
2 points
Low Risk 1.96
3.24
4.10
3 points
4 points
Low - Intermediate Risk 6.37
7.61
5 points
6 points
High - Intermediate Risk 11.35
14.63
7 points
8 points
9 points
10 points
11 points
12 points
High Risk 22.23
24.52
28.10
24.45
N/A
N/A




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