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

O'Brien, Emily C

Simon, DaJuanicia N

Thomas, Laine E

Hylek, Elaine M

Gersh, Bernard J

Ansell, Jack E

Kowey, Peter R

Mahaffey, Kenneth W

Chang, Paul

Fonarow, Gregg C

Pencina, Michael J

Piccini, Jonathan P

Peterson, Eric D

England

2017-07-06T15:33:49Z

2017-07-06T15:33:49Z

2015-12-07

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.

https://www.ncbi.nlm.nih.gov/pubmed/26424865

ehv476

1522-9645

https://hdl.handle.net/10161/15004

eng

Oxford University Press (OUP)

Eur Heart J

10.1093/eurheartj/ehv476

Anticoagulants

Atrial fibrillation

Major bleeding

Risk prediction

Aged

Aged, 80 and over

Anticoagulants

Atrial Fibrillation

Female

Hemorrhage

Humans

Male

Middle Aged

Point-of-Care Systems

Prospective Studies

Registries

Risk Assessment

Risk Factors

Stroke

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

Journal article

O'Brien, Emily C|0000-0002-8257-7561

Pencina, Michael J|0000-0001-5798-8855|0000-0002-1968-2641

Piccini, Jonathan P|0000-0003-0772-2404

Peterson, Eric D|0000-0002-5415-4721

https://www.ncbi.nlm.nih.gov/pubmed/26424865

3258

3264

46

Basic Science Departments

Biostatistics & Bioinformatics

Clinical Science Departments

Duke

Duke Clinical Research Institute

Institutes and Centers

Medicine

Medicine, Cardiology

Medicine, Clinical Pharmacology

School of Medicine

Published

36