What are the limitations of using biomarkers to predict bleeding risks in AF patients?
Biomarkers can be 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. Many biomarkers (eg, troponin, natriuretic peptides, in ammatory markers, coagulation markers, etc) are also predictive of stroke, bleeding, death, HF, hospitalization. The performance of biomarker-based scores in real-world clinical practice (outside highly selected trial cohorts) has also 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' risks as well as modification of risk factors. 