Lv et al reported the Alfalfa-DOAC-GIB score to identify a patient receiving a direct oral anticoagulant agent (DOAC) who is at risk for a major gastrointestinal bleed. The authors are from Fujian Medical University, Chongqing University and affiliated hospitals.
Alfalfa is the name for the research group and represents happiness and luck.
Patient selection: therapy with a direct oral anticoagulant (DOAC)
Examples of direct oral anticoagulants: dabigatran, rivaroxaban
Parameters:
(1) age of the patient in years
(2) alcohol use
(3) history of peptic ulcer
(4) history of major bleeding
(5) abnormal liver function tests
(6) abnormal renal function
(7) cancer
(8) platelet count in 10^9/L
(9) anemia
(10) therapy with an antiplatelet agent
(11) therapy with NSAID
(12) therapy with a gastrointestinal protective agent (proton pump inhibitor, histamine-2 receptor antagonist, other)
|
Parameter
|
Findiing
|
Points
|
|
age of the patient
|
< 65 years
|
0
|
|
|
>= 65 years
|
2
|
|
alcohol use
|
no
|
0
|
|
|
yes
|
1
|
|
history of peptic ulcer
|
no
|
0
|
|
|
yes
|
2.5
|
|
history of major bleeding
|
no
|
0
|
|
|
yes
|
3.5
|
|
abnormal liver function
|
no
|
0
|
|
|
yes
|
3
|
|
abnormal renal function
|
no
|
0
|
|
|
yes
|
2
|
|
cancer
|
no
|
0
|
|
|
yes
|
2.5
|
|
platelet count
|
>= 100 * 10^9/L
|
0
|
|
|
< 100 * 10^9/L
|
2.5
|
|
anemia
|
no
|
0
|
|
|
yes
|
1.5
|
|
antiplatelet agent
|
no
|
0
|
|
|
yes
|
1.5
|
|
NSAID
|
no
|
0
|
|
|
yes
|
1.5
|
|
GI protective agent
|
no
|
0
|
|
|
yes
|
-3.5
|
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: -3.5
• maximum score: 23.5
• A score >= 3.5 has an odds ratio of 4.3.
Performance:
• The area under the ROC curve is 0.77.
