Don't Rely on Scoring Systems to Predict Clinically Important Bleeding During Oral Anticoagulant Therapy

Clinicians are trying constantly to weigh risks and benefits of oral anticoagulant therapy. For bleeding risk, numerous scoring systems have been developed to help guide clinical decision making for patients who take warfarin. These scores generally are assumed to be more accurate than clinical judgment.

In a single-center prospective study, researchers in Switzerland compared the performance of seven scoring systems versus clinical judgment for predicting risk for first major bleeding event in 515 patients (median age, 71) who were receiving vitamin K antagonists that were comparable to warfarin (acenocoumarol or phenprocoumon). Most patients were anticoagulated for one of three conditions: atrial fibrillation (61%), venous thromboembolic d…