Background: Modified HAS-BLED score (mHAS-BLED) is reportedly useful to predict periprocedural bleeding after cardiac ablation procedures. However, it remains to be elucidated whether the score is also useful to estimate the risk of bleeding after device procedures.
Objective: The present study was carried out to investigate how mHAS-BLED score predicted the risk of peri-procedural bleeding around implantation of implantable cardioverter defibrillators (ICDs).
Methods: We retrospectively investigated clinical course of patients who underwent implantations of ICDs. Modified HAS-BLED score, which excluded labile INR, was calculated in each patient. The primary endpoint was defined as any bleeding complications requiring additional medical therapy including prolonged compression and surgical interventions.
Results: In total of 331 patients (62.0±12.8years, 94 females, 115 CRT-Ds) enrolled, bleeding complications occurred in 34 patients (30 pocket hematoma, 3 pericardial effusion, and 1 lung injury). Warfarin potassium was administered in 84 patients (25.3%), while direct oral anticoagulants (DOACs) were used in 51 patients (15.4%). The frequency of bleeding was: 4.6% in no-OAC group, 14.3% in Warfarin group, and 23.5% in DOAC group. As for mHAS-BLED score, periprocedural bleeding was significantly more frequent in high scores (Score 0: 0%, 1: 4.5%, 2: 14.3%, 3: 16.4%, >4: 21.6%, P<0.001). The same trend was still observed if limited to DOAC group (Score≤1: 7.7%, 2: 22.7%, 3: 33.3%, >4: 50%).
Conclusion: Modified HAS-BLED score may potentially stratify the risk of bleeding after implantation of ICD.