Comparison of HAS-BLED and ORBIT Bleeding Risk Scores in AF Patients treated with NOACs: A Report from the ESC-EHRA EORP-AF General Long-Term Registry

Marco Proietti*, Giulio Francesco Romiti, Marco Vitolo, Tatjana S. Potpara, Giuseppe Boriani, Gregory Y.H. Lip, ESC-EHRA EORP-AF Long-Term General Registry Investigators, Sam Riahi (Medlem af forfattergruppering), Albert Marni Joensen (Medlem af forfattergruppering), Anders Gammelmark (Medlem af forfattergruppering), Lars Hvilsted Rasmussen (Medlem af forfattergruppering), Pia Thisted Dinesen (Medlem af forfattergruppering), Stine Krogh Venø (Medlem af forfattergruppering), Birthe Ginnerup Sørensen (Medlem af forfattergruppering), Anne Marie Korsgaard (Medlem af forfattergruppering), Karen Petrea Andersen (Medlem af forfattergruppering), Camilla Fragtrup Hellum (Medlem af forfattergruppering)


Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review


INTRODUCTION: Bleeding risk assessment is recommended in guidelines for the management of atrial fibrillation (AF). HAS-BLED score was proposed prior to non-vitamin K antagonist oral anticoagulants (NOACs) and has been suggested that the ORBIT score may be superior in predicting bleeds in NOAC users. We aimed to compare the HAS-BLED and ORBIT scores in contemporary AF patients treated with NOACs.

METHODS AND RESULTS: We analyzed patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. HAS-BLED and ORBIT scores were computed based on original schemes. The primary outcome was the occurrence of Major Bleeding (MB). A total of 3018 patients (median age 70; 39.6% females) were included: median [IQR] HAS-BLED and ORBIT scores were 1 [1-2] and 1 [0-2], respectively; 356 (11.8%) patients were at high risk for MB using HAS-BLED (≥3) and 123 (4.1%) using ORBIT (≥4). Overall, 60 (2.0%) MB events were recorded, with an incidence of 1.1 per 100 patient-years.Both HAS-BLED and ORBIT were associated with outcome, modestly predicting MB (AUC 0.653, 95% CI 0.593-0.714 and AUC 0.601, 95% CI 0.526-0.677, respectively). Calibration plots showed that both scores were poorly calibrated, particularly the ORBIT score, which showed consistent poorer calibration. Time-dependent reclassification analysis showed a trend towards incorrect lower risk reclassification using ORBIT compared to HAS-BLED.

CONCLUSION: In this real-life contemporary cohort of AF patients treated with NOACs, the ORBIT score did not provide reclassification improvement, showing even poorer calibration compared to HAS-BLED. Our findings do not support the preferential use of ORBIT in NOAC-treated AF patients.

TidsskriftEuropean heart journal. Quality of care & clinical outcomes
StatusE-pub ahead of print - 23 sep. 2021

Bibliografisk note

© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.


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