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New QBleed tools to help guide anticoagulation in UK general practice

UK researchers have developed risk algorithms to help GPs weigh up the risk of digestive tract or intracranial bleeding when starting a patient on an anticoagulation.

The QBleed algorithms – from the team that developed QRISK – were developed using UK primary care data and can be used to automatically generate a score on GP computer systems.

The team said the QBleed tools are likely to be more representative of UK primary care patients than the HAS-BLED tool that was recently recommended in updated NICE guidance on atrial fibrillation.

Nottingham University researchers Professor Julia Hippisley-Cox, professor of clinical epidemiology and general practice, and Professor Carol Coupland, associate professor and reader in medical statistics, describe how they developed and validated the QBleed tools in a BMJ article.

The team used QResearch data for nearly six million patients to develop and validate the two tools based on 21 variables – including sociodemographic factors, lifestyle, morbidity, drugs and laboratory tests such as abnormal platelet function – that strongly predicted either gastrointestinal or intracranial bleeding.

The researchers said further research is needed to come up with a specific risk threshold for intervention or avoiding anticoagulants, but that they envisage GPs will use the tools to discuss with individual patients the risks of bleeding with or without anticoagulation, compared with the risk of stroke or thrombosis, to ‘balance the estimated absolute individualised risks and benefits to inform the decision about anticoagulants’.

They added: ‘The doctor and patient also can review factors that might ameliorate the risks, such as amending concurrent drugs.’

‘Overall this could help the doctor and patient assess whether the balance of risks and benefits is likely to be favourable or not.’

BMJ 2014; available online 28 July

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