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The ORBIT bleeding score: a simple bedside score to assess bleeding risk in atrial fibrillation.

dc.contributor.author Ansell, JE
dc.contributor.author Chang, P
dc.contributor.author Fonarow, GC
dc.contributor.author Gersh, Bernard John
dc.contributor.author Hylek, EM
dc.contributor.author Kowey, Peter R
dc.contributor.author Mahaffey, Kenneth William
dc.contributor.author O'Brien, Emily C
dc.contributor.author Pencina, MJ
dc.contributor.author Peterson, Eric David
dc.contributor.author Piccini, Jonathan Paul Sr
dc.contributor.author Simon, DN
dc.contributor.author Thomas, Laine Elliott
dc.coverage.spatial England
dc.date.accessioned 2017-07-06T15:33:49Z
dc.date.available 2017-07-06T15:33:49Z
dc.date.issued 2015-12-07
dc.identifier https://www.ncbi.nlm.nih.gov/pubmed/26424865
dc.identifier ehv476
dc.identifier.uri https://hdl.handle.net/10161/15004
dc.description.abstract BACKGROUND: Therapeutic decisions in atrial fibrillation (AF) are often influenced by assessment of bleeding risk. However, existing bleeding risk scores have limitations. OBJECTIVES: We sought to develop and validate a novel bleeding risk score using routinely available clinical information to predict major bleeding in a large, community-based AF population. METHODS: We analysed data from Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF), a prospective registry that enrolled incident and prevalent AF patients at 176 US sites. Using Cox proportional hazards regression, we identified factors independently associated with major bleeding among patients taking oral anticoagulation (OAC) over a median follow-up of 2 years (interquartile range = 1.6-2.5). We also created a numerical bedside risk score that included the five most predictive risk factors weighted according to their strength of association with major bleeding. The predictive performance of the full model, the simple five-item score, and two existing risk scores (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile INR, elderly, drugs/alcohol concomitantly, HAS-BLED, and anticoagulation and risk factors in atrial fibrillation, ATRIA) were then assessed in both the ORBIT-AF cohort and a separate clinical trial population, Rivaroxaban Once-daily oral direct factor Xa inhibition compared with vitamin K antagonism for prevention of stroke and embolism trial in atrial fibrillation (ROCKET-AF). RESULTS: Among 7411 ORBIT-AF patients taking OAC, the rate of major bleeding was 4.0/100 person-years. The full continuous model (12 variables) and five-factor ORBIT risk score (older age [75+ years], reduced haemoglobin/haematocrit/history of anaemia, bleeding history, insufficient kidney function, and treatment with antiplatelet) both had good ability to identify those who bled vs. not (C-index 0.69 and 0.67, respectively). These scores both had similar discrimination, but markedly better calibration when compared with the HAS-BLED and ATRIA scores in an external validation population from the ROCKET-AF trial. CONCLUSIONS: The five-element ORBIT bleeding risk score had better ability to predict major bleeding in AF patients when compared with HAS-BLED and ATRIA risk scores. The ORBIT risk score can provide a simple, easily remembered tool to support clinical decision making.
dc.language eng
dc.relation.ispartof Eur Heart J
dc.relation.isversionof 10.1093/eurheartj/ehv476
dc.subject Anticoagulants
dc.subject Atrial fibrillation
dc.subject Major bleeding
dc.subject Risk prediction
dc.subject Aged
dc.subject Aged, 80 and over
dc.subject Anticoagulants
dc.subject Atrial Fibrillation
dc.subject Female
dc.subject Hemorrhage
dc.subject Humans
dc.subject Male
dc.subject Middle Aged
dc.subject Point-of-Care Systems
dc.subject Prospective Studies
dc.subject Registries
dc.subject Risk Assessment
dc.subject Risk Factors
dc.subject Stroke
dc.title The ORBIT bleeding score: a simple bedside score to assess bleeding risk in atrial fibrillation.
dc.type Journal article
pubs.author-url https://www.ncbi.nlm.nih.gov/pubmed/26424865
pubs.begin-page 3258
pubs.end-page 3264
pubs.issue 46
pubs.organisational-group Basic Science Departments
pubs.organisational-group Biostatistics & Bioinformatics
pubs.organisational-group Clinical Science Departments
pubs.organisational-group Duke
pubs.organisational-group Duke Clinical Research Institute
pubs.organisational-group Institutes and Centers
pubs.organisational-group Medicine
pubs.organisational-group Medicine, Cardiology
pubs.organisational-group Medicine, Clinical Pharmacology
pubs.organisational-group School of Medicine
pubs.publication-status Published
pubs.volume 36
dc.identifier.eissn 1522-9645


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