ArticleCirculation2023
Development and Validation of the DOAC Score: A Novel Bleeding Risk Prediction Tool for Patients With Atrial Fibrillation on Direct-Acting Oral Anticoagulants.
Article in Circulation, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 53 papers, 2 of them syntheses that pooled it.
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Who cites it
53 citing papers in PubMed, 2 syntheses or guidelines pooled it, 96 citations in OpenAlex.
- DOAC Score Versus HAS-BLED and ORBIT for Predicting Bleeding Events in Atrial Fibrillation on Direct Oral Anticoagulants.Clinical cardiology · 2026Pooled it
- Efficacy and safety of direct oral anticoagulants in pediatric patients: a systematic review and meta-analysis.Frontiers in public health · 2026Pooled it
- VARC-HBR criteria validation in TAVI patients on oral anticoagulation.EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology · 2025Trial
- Changes in the use of vitamin K antagonists and direct oral anticoagulants and impact on the incidence of oral anticoagulation-related intracerebral hemorrhage: population-wide prescription patterns in two 5-year cohorts.Annals of medicine · 2026Observational
- Expanded Application of the DOAC Score for Predicting Bleeding Events in All Anticoagulated Patients With Atrial Fibrillation: An Integrated Analysis of 2 Prospective Japanese Registries-RAFFINE and SAKURA-AF.Circulation reports · 2026Article
- Managing bleeds on anticoagulant therapy: a practical guide for clinicians.European heart journal. Acute cardiovascular care · 2026Review
- Machine learning to identify novel bleeding and residual thromboembolic risks in patients on anticoagulation.Journal of thrombosis and thrombolysis · 2026Article
- Machine learning in bleeding risk assessment for low-molecular-weight heparin or fondaparinux: a predictive model study.Scientific reports · 2026Observational
- Performance of Bleeding Risk Scores for Major Bleeding in Anticoagulated Patients with Pulmonary Embolism: Insights from the CURES Registry-2.Thrombosis and haemostasis · 2026Article
- Disparities in gastrointestinal bleeding and acute myocardial infarction-related mortality in the United States, 1999-2020.Internal and emergency medicine · 2026Article
- Edoxaban for stroke prevention in Chinese patients with atrial fibrillation: 1-year follow-up of the ETNA-AF-China study.Frontiers in pharmacology · 2026Article
- A microdose cocktail and population pharmacokinetic study suggests potentially reduced CYP3A and P-gp activities in type 2 diabetes.Frontiers in pharmacology · 2026Article
- Application of Artificial Intelligence in the Early Detection and Management of Atrial Fibrillation: State-of-the-art Review.European cardiology · 2026Review
- Hemorrhagic Complications in Patients with Atrial Fibrillation Treated with Novel Oral Anticoagulants: Results from the CRAFT Study.Journal of clinical medicine · 2025Article
- Development and Validation of Dynamic Prediction Model for Thromboembolic and Bleeding Risk in Patients With Atrial Fibrillation Initiating Direct Oral Anticoagulants.Journal of the American Heart Association · 2025Article
- Expert Review of the Strategies to Optimize Long-Term Outcomes After Coronary Artery Bypass Grafting.Reviews in cardiovascular medicine · 2025Review
- Factor XI inhibitors for the prevention and treatment of venous and arterial thromboembolism.Nature reviews. Cardiology · 2025Review
- Apixaban in subclinical atrial fibrillation: stroke-driven value amid economic uncertainty.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2025Article
- Performance of DOAC and HAS-BLED scores in predicting major bleeding in Asian patients with non-valvular atrial fibrillation receiving direct oral anticoagulants.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2025Article
- A Clinical Prediction Model for Atypical Tuberculosis Manifestations Among Older Adults.Medicina (Kaunas, Lithuania) · 2025Article
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14 authors at 10 institutions in 3 countries.
Funding
Abstract
backgroundCurrent clinical decision tools for assessing bleeding risk in individuals with atrial fibrillation (AF) have limited performance and were developed for individuals treated with warfarin. This study develops and validates a clinical risk score to personalize estimates of bleeding risk for individuals with atrial fibrillation taking direct-acting oral anticoagulants (DOACs).
methodsAmong individuals taking dabigatran 150 mg twice per day from 44 countries and 951 centers in this secondary analysis of the RE-LY trial (Randomized Evaluation of Long-Term Anticoagulation Therapy), a risk score was developed to determine the comparative risk for bleeding on the basis of covariates derived in a Cox proportional hazards model. The risk prediction model was internally validated with bootstrapping. The model was then further developed in the GARFIELD-AF registry (Global Anticoagulant Registry in the Field-Atrial Fibrillation), with individuals taking dabigatran, edoxaban, rivaroxaban, and apixaban. To determine generalizability in external cohorts and among individuals on different DOACs, the risk prediction model was validated in the COMBINE-AF (A Collaboration Between Multiple Institutions to Better Investigate Non-Vitamin K Antagonist Oral Anticoagulant Use in Atrial Fibrillation) pooled clinical trial cohort and the Quebec Régie de l'Assurance Maladie du Québec and Med-Echo Administrative Databases (RAMQ) administrative database. The primary outcome was major bleeding. The risk score, termed the DOAC Score, was compared with the HAS-BLED score.
resultsOf the 5684 patients in RE-LY, 386 (6.8%) experienced a major bleeding event, within a median follow-up of 1.74 years. The prediction model had an optimism-corrected C statistic of 0.73 after internal validation with bootstrapping and was well-calibrated based on visual inspection of calibration plots (goodness-of-fit
conclusionsIn individuals with atrial fibrillation potentially eligible for DOAC therapy, the DOAC Score can help stratify patients on the basis of expected bleeding risk.
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