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A new model (Alfalfa-Warfarin-GIB) for predicting the risk of major gastrointestinal bleeding in warfarin patients

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Abstract

Background

This study aimed to analyze the factors influencing warfarin-related major gastrointestinal bleeding (GIB) and to develop a score that would provide a reference for assessing the risk of major GIB associated with warfarin treatment.

Methods

This was a retrospective analysis of clinical and follow-up data from warfarin-treated patients. Scores were analyzed using logistic regression. The area under the subject working characteristic curve (AUC), sensitivity, specificity, and Hosmer-Lemeshow test were used to evaluate the scoring performance.

Results

A total of 1591 patients who met the requirements for warfarin use were included in this study, and 46 developed major GIB. After univariate analysis as well as multivariate logistic regression analysis, nine factors were found to be associated with increased risk of major GIB, namely age ≥ 65 years, history of peptic ulcer, history of major bleeding, abnormal liver function, abnormal renal function, cancer, anemia, labile international normalized ratio, and combination of antiplatelet agents/non-steroidal anti-inflammatory drugs. The Alfalfa-Warfarin-GIB score was constructed using these nine factors. The AUC and Bootstrap method-corrected AUC of the Alfalfa-Warfarin-GIB score were 0.916 (95% CI: 0.862–0.970, P < 0.001) and 0.919 (95% CI: 0.860–0.967, P < 0.001), respectively, which were higher than those of the HAS-BLED score (AUC = 0.868, 95% CI: 0.812–0.924, P < 0.001).

Conclusion

Based on nine risk factors, the Alfalfa-Warfarin-GIB score was constructed to predict the risk of warfarin-related major GIB. The newly developed Alfalfa-Warfarin-GIB score has a better predictive value than the HAS-BLED score and may be an effective tool to help reduce the occurrence of major GIB in patients on warfarin.

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Availability of data and material

The data presented in this study are available on request from the corresponding author.

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Funding

This study was funded by the Science and Technology Innovation Startup Foundation of Fujian Provincial Maternal and Child Health Hospital (YCXY23-02).

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Authors and Affiliations

  1. Department of Pharmacy, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, #18 Daoshan Road, Fuzhou, 350001, China

    Shuyi Wu, Meina Lv, Fuxin Ma & **hua Zhang

  2. Department of Cardiology, Fujian Medical University Union Hospital, Fuzhou, China

    Zhang Feilong

  3. Department of Cardiac Surgery, Fujian Medical University Union Hospital, Fuzhou, China

    Guanhua Fang

Authors
  1. Shuyi Wu
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  2. Meina Lv
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  3. Fuxin Ma
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  4. Zhang Feilong
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  5. Guanhua Fang
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  6. **hua Zhang
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Contributions

JZ initiated the study. JZ, SW, ML, FM, FZ, and GF collected and entered the data. ML and FM performed data collation. SW and ML performed data extraction and analyses. SW drafted the first version of the manuscript. JZ, SW, ML, FM, FZ, and GF critically reviewed and revised the manuscript. SW and FZ worked on data validation. SJ performed the graphical revisions. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to **hua Zhang.

Ethics declarations

Ethical approval

The study complies with the Declaration of Helsinki and was authorized by The Ethics Committee of Fujian Medical University Union Hospital.

Informed consent

The requirement for patient consent was waived due to its retrospective nature.

Conflict of interest

The authors declare that they have no conflicts of interest.

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Wu, S., Lv, M., Ma, F. et al. A new model (Alfalfa-Warfarin-GIB) for predicting the risk of major gastrointestinal bleeding in warfarin patients. Eur J Clin Pharmacol 79, 1195–1204 (2023). https://doi.org/10.1007/s00228-023-03533-0

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  • DOI: https://doi.org/10.1007/s00228-023-03533-0

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