What is the performance of biomarker-based scores in real-world clinical practice?
The performance of biomarker-based scores in real-world clinical practice (outside highly selected trial cohorts) has been disappointing, given that baseline (or near-baseline) determination of biomarkers to predict bleeding risks after many years is bedeviled by the changing clinical risk profile of patients and modification of risk factors. Furthermore, biomarkers are expensive, and may be subject to laboratory variability, inter-assay differences, diurnal variation and may change in individual patients depending on how risk factors and drug treatments change over time.