Oral anticoagulant safety in family practice: prognostic accuracy of Bleeding Risk Scores (from the CACAO study)
Authors: Gaboreau Yoann , Frappé Paul , Vermorel Céline , Foote Alison , Bosson Jean-Luc , Pernod Gilles ,   CACAO study investigators, Abenhaïm Nathan , Ackermann Sophie , Blanpain Maryse Adam , Andreu Xavier , Arnould Céline , Atlan-Cottin Audrey , Aubert Jean-Pierre , Aubin-Auger Isabelle , Aubry Jacques , Augueux Julien , Augustin Veena , Bakry Annick , Baldesi Marine , Banoun Eric , Barberet Eric , Bardet Rémi , Barriere Florence , Baruch Dan , Baude Nicolas , Bayen Marc , Bayen Sabine , Bayle François , Beaufils Yannick , Beaupin Alain , Bedel-Chauvaud Julie , Bel Raphaël , Bellier Martine , Bendamene Farouk , Berard Philippe , Berbé Cédric , Berkhout Christophe , Berland Jacques , Béthembos Charles-Edouard , Billiard Pierre-Yves , Bisch Olivier , Bizeau Aurélie , Blanchard Paul , Blanquart Guy , Boch Aurélie , Bodein Isabelle , Boige Emmanuel , Bonin Claude , Bonis Anne-Laure , Bonnard Marie-Pierre , Bonnet Pascal , Bonnet Pierre-André , Bosselut Gérard , Bottet Anne , Bouche Philippe , Boucherle Bérengère , Bougeard Audrey , Bouhana Serge , Boukeloul Mourad , Boulet-Gercourt Jean , Boulongne Jean-Marie , Bouniol Lionel , Bourcart Jean-Jacques , Bourgoin Michel , Bourguignon-Vartanian Véronique , Bouteville Claire , Boutin Philippe , Boutmy Annelore , Brenner-Girault Evelyne , Breton Nicolas , Briane-Fraysse Muriel , Brodbeck Marina , Brunet Olivier , Buchinger Ariel , Buffaz-Sutra Anne , Bur Marc , Cabourdin Philippe , Cachera Philippe , Cailliez Eric , Calafiore Matthieu , Calvet Denis , Camedescasse Pierre , Canart Hervé , Cancade Michel , Candelier Christophe , Capiod Christian , Carin Thierry , Caron Olivier , Carré Elisa , Carrillo Yannick , Casagrande Nathalie , Causse Pierre , Chabert Gaëlle , Chabord Frédérick , Chambe Juliette , Chambon Guillaume , Champeaux Richard , Charbonnel Laurent , Charles Rodolphe , Charra Clément , Chartier Samuel , Chastang Julie , Chatelard Sophia , Chatillon Eric , Chauvot Laurent , Chelle Hervé , Chenuet Stéphane , Chevalier Nicolas , Chevillot David , Cibeer Jean-Pierre , Cittée Jacques , Claudel Jean-François , Clemence Yvonnick , Clerget Jean-Paul , Clusier-Jeudy Isabelle , Coispeau Marie-Pierre , Colin Arnaud , Collart-Dutilleul Hervé , Compagnon Laurence , Compan Malet Marine , Connan Laurent , Conrad Hubert , Coquillaud Bruno , Cormier Jean-Luc , Couette Jean-Charles , Cournoyer Yves , Cousin Christian , Creton Stephen , Crignon Jean-Jacques , Cros André , Cunin Michel , Cussac Emmanuel , Dailly Jean-Maurice , Danvin Didier , Darnaut Pierre-Marie , Daubin Bruno , De L’Hamaide Thomas , De Saint Meleuc Yves , De Taddeo Sabine , Decker Jean-Luc , Decobert Anne , Delattre Yannick , Delavenne Christine , Delavenne Loïc , Delbru Bénédicte , Deleplanque Denis , Delerive Nicole , Delesalle Laurent , Delforge François , Delgrange Jean-Paul , Delpierre Jean-Pierre , Demeulemeester Eric , Derain Nicolas , Descombe Fabrice , Desmoulins Thierry , Deville-Carollo Marie-Claire , Dherbecourt Jean-Michel , Didierjean Michael , Domrane Salima , Douzou Brigitte , Druart Sabine , Dubeau Xavier , Dubedat Arnaud , Dudragne Résika , Duez Christian , Dufour Lucien , Duhamel Sylvie , Duisit Lionel , Dumoitier Nathalie , Dumond Hervé , Dumortier Julien , Duquesne Emilie , Durand David , Durieux William , Durot Philippe , Duss Taous , Eschalier Bénédicte , Espiard Eric , Eterstein Pierre , Etienney Joël , Faidix Xavier , Famery Patrice , Faria David , Faure Renaud , Ferrer André , Ferrer Jean-Marie , Feuillet Jean , Fivel Christian , Flaissier Christian , Fortané Julien , Forté Jenny , Fossé Claude , Foucat Joël , Fouillard Christophe , Fournier Vianney , Fournier Virginie , Fraizy Déborah , Frappé Paul , Frenoy-Sansarricq Isabelle , Gabbai Bernard , Gaboreau Yoann , Gaillard Fabien , Garnier Isabelle , Garnier Jean-Michel , Gascoin Jean-Claude , Gault Yves , Gaultier Martine , Gay Bruno , Gédon Benoît , Genies Christophe , Géniole Jean-Marc , Gentner Jean-Luc , Ghez Jean-Louis , Giraldi Charles , Girard Christian , Giraud Philippe , Godart Sylvain , Goidin Pierre , Gomez Aline , Goncalves Céline , Gouget Arnaud , Gouget Marie-Laure , Gournay Sylvain , Grand Florence , Granier Jean-Claude , Greffe Roland , Grutter Sabine , Gryb Catherine , Guedel François-Xavier , Guérin Mathieu , Guiberteau Julien , Guille Jean-François , Guillot Jean-Pierre , Guillou Philippe , Gustin Gilles , Guyot Anne , Guyot Jean-Marie , Hardy Christophe , Hassid David , Hayani Latifa , Heller Anne , Henriot Frédéric , Hermouet Thierry , Hoenner Hecht Bénédicte , Honvoh Senadjro Ferreol , Houdard Gaëtan , Huas-Suarez Isabelle , Huber Corinne , Imbert Patrick , Jacques Pascal , Jacquet Cécile , Jacquet Jean-Pierre , Jacquiot Denis , Jacquot Philippe , Jaffre Samy , Jean Clémence , Jeanmougin Pauline , Jeudy Isabelle , Joseph Jean-Philippe , Jouannic Pierre , Jousson Stéphanie , Kastelik André , Klifa Gérard , Knockaert François-René , Koch Jean-Philippe , Krotoff Julia , Labrune Charlotte , Lacaille-Smerilli Véronique , Lacoin François , Lainé Xavier , Lambert Philippe , Lambourg Audrey , Lamy Dominique , Lapenne-Creusot Myriam , Laporte Jean-Dominique , Lartaud Lucie , Lauchet Nadège , Lavielle Dorothée , Le Breton Julien , Le Diagon Raphaël , Le Du Marie , Le Goff Delphine , Le Lann Claire , Le Mouël Stéphane , Leblan-Depelsenaire Carole , Leclercq Frédéric , Lécutier Rudolphe , Ledoux Jean-Nicolas , Lefebvre Jean-Marc , Léger Pascal , Lendais Robert , Lengagne Eric , Sosiewicz-Lengsavath Catherine , Lenoir Sylvie , Lerouge Patrick , Leroy Benoît , Leung-Y-Tai Ida , Ligier Pascal , Lobel Charlotte , Loez François , Lognos Béatrice , Luaces Baptiste , Lucas-Couturier Laurence , Lunven Anne , Machraoui Sigolène , Maciejewski André , Magnen Loïc , Makridis Georgios , Malbrunot Jean-Luc , Mancini Jean-Marc , Mangin Hervé , Maniglier Jean-Marc , Marchant Philippe , Marcus Julie , Marien Guillaume , Martin-Etzol Anne-Laure , Mas Christian , Masset Yannick , Massin Pierre , Masson Bruno , Mattera Agnès , Matz Charlotte , Maufoy François , Maury Collette , Mavraganis Laure-Emmanuelle , Mazin Olivier , Mazué Lison , Melizan Jean-Philippe , Menard Dominique , Mercier Alain , Mercier Patricia , Meyer Patric-Alain , Michellier Philippe , Milleret Corinne , Millot Yannick , Minard Françoise , Miqueu Marie-Léa , Mismacque Dany , Mitifiot Catherine , Moebs Jean-Louis , Monnier Jean-Michel , Montariol Yves , Montauze Jérémie , Morand Alain , Morel Gilles , Morlon François , Mortas Delphine , Motte Baptiste , Mouget Stéphane , Munro Luc , Naessens Martin , Nammathao Bounthanousone , Negre Dominique , Nogrel Charlie , Nouvellet Lucile , Nureni Banafunzi Ismaël , Oger Thierry , Ortholan Jean-François , Osty Dominique , Oude Engberink Agnès , Paillard Guy-Marc , Paillard Laurent , Pautout-Guillaume Marie-Paule , Pech-Gourg Laurent , Perdrix Corinne , Perez Véronique , Perrillat-Amédé Ségolène , Peyrou Christophe , Pichat Bruno , Pigache Christophe , Pinot Alexis , Piquard Dominique , Piquet Thierry , Placet Michel , Plauchier Michel , Pluskota Caroline , Ponchant Maurice , Prat Chantal , Prevost Martine , Prigent Jean-Pierre , Py Thibaut , Rafin Christian , Rambaud Jacques , Rapoud Jean-Paul , Regnier Anne-Marie , Renaudin Sylvain , Rétaux Jean-Michel , Richard Amélie , Richetta Philippe , Rigault Jean-Michel , Rigoli Reinold , Ritter-Meinicke Anne , Robert Sarah , Rollin Stéphanie , Rondepierre Didier , Rosenberg Sophie , Roth Mélanie , Rougerie Fabien , Royer De Vericourt Guillaume , Rudelle Karen , Ruelle Philippe , Ruetsch Marcel , Saillard Dominique , Saint-Denis Pénélope , Sannelli Pietro , Saraidarian Philippe , Sastourné Jean-Pascal , Sauvage Laurent , Scellier Christian , Schaal Christian , Schelcher François-Xavier , Schirlin Daniel , Schirrer Anne , Schlienger Claude , Schlienger Joëlle , Serayet Philippe , Serramoune Denis , Siebler Marlène , Simon Jean-Paul , Soares André , Soussotte-Ducasse Carine , Stefanuto Philippe , Steinberger Marc , Szapiro Marianne , Taha Anas , Taluy Erol , Tanguy Gilles , Tardieux Dominique , Tardy Michel , Tavernier Benoît , Ténédos Jean-Luc , Thelot-Bach Lorène , Tisserand Rémy , Tordoir Audrey , Trillot François , Triouleyre Pascal , Truong David , Turi Laurent , Vaillant Frédéric , Vaillant-Roussel Hélène , Vailler Pierre , Vallee Josette , Vampouille Muriel , Vangi Jean-Louis , Vannier Fabien , Varin Simon , Vaugeois Florence , Vauthier Jean-Charles , Vauthier Virginie , Veillard Delphine , Verjus Anne-Laure , Verjus Paul-Bernard , Verney Gilles , Vialtel Eloïse , Vierling Fernand , Virgone-Rebaud Graziella , Vital-Durand Marc , Vittori Eric , Volcler Nadège , Vorilhon Philippe , Watteau Pierre , Weisbecker Christine , Wey Nathalie , Wilhelm-Nenot Françoise , Wurtz Jean-Louis , Yvon Patricia , Zabawa Claire , Zamboni Jean-Marc , Zipper Anne-Claire 
Published: January 2024

Abstract

Background
To assess bleeding risk of patients treated by oral anticoagulants, several scores have been constructed to assist physicians in the evaluation of the benefit risk. Most of these scores lack a strong enough level of evidence for use in family practice.

Objective
To assess the predictive prognostic accuracy of 13 scores designed to assess the risk of major or clinically relevant non-major (CRNM) bleeding events in a French ambulatory cohort receiving Vitamin-K antagonists (VKA) or direct oral anticoagulants (DOACs) in a family practice setting.

Methods
CACAO (Comparison of Accidents and their Circumstances with Oral Anticoagulants) was a multicentre prospective cohort of ambulatory patients prescribed oral anticoagulants. We selected patients from the cohort who had received an oral anticoagulant because of non-valvular atrial fibrillation (NVAF) and/or venous thromboembolism (VTE) to be followed during one year by their GP. The following scores were calculated: mOBRI, Shireman, Kuijer, HEMORR2HAGES, ATRIA, HAS-BLED, RIETE, VTE-BLEED, ACCP score, Rutherford, ABH-Score, GARFIEL-AF, and Outcomes Registry for Better InformedTreatment of Atrial Fibrillation (ORBIT). Prognostic accuracy was assessed by using receiver operating characteristic curves and c-statistics.

Results
During 1 year, 3,082 patients were followed. All of the scores demonstrated only poor to moderate ability to predict major bleeding or CRNM in NVAF patients on DOACs (c-statistic: 0.41–0.66 and 0.45–0.58), respectively. The results were only slightly better for patients prescribed VKA (0.47–0.66 and 0.5–0.55, respectively) in this indication. The results were also unsatisfactory in patients treated for VTE.

Conclusion
None of the scores demonstrated satisfactory discriminatory ability when used in family practice.

Clinical Trial Registration
ClinicalTrials.gov NCT02376777