JHL Consultants

Medical Applications

The DOAC Score application has been written for the use of cardiologists, not the general public. Should a member of the general public make use of this score to assess their risk of a one year bleed related to the use of direct acting anticoagulants for treatment of atrial fibrillation, they should consult the doctor prescribing this medication for advice. A high or very high score may suggest that additional treatment regimes may be indicated.

The DOAC score represents a significant scientific advance in anticoagulation management that balances the benefit of preventing stroke and systemic embolisation with the risk of bleeding in patients with atrial fibrillation.The DOAC score allows the clinician to accurately quantify bleeding risk in patients taking DOACs while also helping identify bleeding risk factors and to correct those that are modifiable such as better controlling blood pressure, removing concomitant unnecessary antiplatelet or NSAID use, and counselling the patient about such factors. The bleeding risk assessment with the DOAC score and its clinical adoption improves patient care, highlight patients in whom risks are reversible, and provides caution when needed.

The DOAC score could also potentially serve as a quantifiable measure with respect to selecting patients who might benefit from left atrial appendage closure and/or catheter ablation.

Reefrences:

1. Aggarwal R, Ruff CT, Virdone S, Perreault S, Kakkar AK, Palazzolo MG, et al. Development and Validation of the DOAC Score: A Novel Bleeding Risk Prediction Tool for Patients With Atrial Fibrillation on Direct-Acting Oral Anticoagulants. Circulation [Internet]. 2023 Sep 19 [cited 2025 Jan 14];148(12):936–46. Available from: https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.064556

2. Ezekowitz MD, Kamareddine M. Filling an Important Knowledge Gap: The DOAC Score. Circulation [Internet]. 2023 Sep 19 [cited 2025 Jan 15];148(12):947–9. Available from: https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.066316

3. Harano Y, Yamamoto M, Shimura T, Okubo M, Koyama Y, Yamaguchi R, et al. Association Between Direct Oral Anticoagulant Score and Bleeding Events in Patients With Atrial Fibrillation Following Transcatheter Aortic Valve Replacement: A Retrospective Multicenter Cohort Study. JAHA [Internet]. 2024 Nov 7 [cited 2024 Nov 15];e036417. Available from: https://www.ahajournals.org/doi/10.1161/JAHA.124.036417