Bleeding risk scores in atrial fibrillation and venous thromboembolism

Patients receiving oral anticoagulant (OAC) therapy for stroke prevention in atrial fibrillation (AF) and prevention of venous thromboembolism (VTE) face an increased risk of bleeding with OAC treatment. Clinicians need to weigh-up the benefits of OAC treatment against the risk of bleeding. To help formalise bleeding risk assessment, various bleeding risk scores have been developed to help predict the risk of bleeding in AF and VTE patients receiving anticoagulant therapy. This review summarises the literature involving original studies deriving bleeding risk scores and validation studies of these scores for stroke prevention in AF and treatment/prevention of VTE. To date, there are 10 bleeding risk scores, 6 for use if AF populations, three in VTE cohorts and 1 for mixed indications; they differ markedly in the number of, and risk factors for bleeding, and complexity. In conclusion, many clinical prediction tools to assess bleeding risk prior to starting OAC for either stroke prevention in AF or treatment of VTE are available and should be used in clinical practice to identify and manage modifiable risk factors.