title: Is the ORBIT Bleeding Risk Score Superior to the HAS-BLED Score in Anticoagulated Atrial Fibrillation Patients?
abstract: BACKGROUND
  Several bleeding risk scores have been validated in patients with atrial fibrillation (AF). The ORBIT score has been recently proposed as a simple score with the best ability to predict major bleeding. The present study aimed to test the hypothesis that the ORBIT score was superior to the HAS-BLED score for predicting major bleeding and death in "real world" anticoagulated AF patients.
  
  
  RESULTS
  We analyzed the predictive performance for bleeding and death of 406 AF patients who underwent 571 electrical cardioversion procedures and 1,276 patients with permanent/persistent AF from the FANTASIIA registry. In the cardioversion population, 21 patients had major bleeding events and 26 patients died. The predictive performance for major bleeding of HAS-BLED and ORBIT were not significantly different (c-statistics 0.77 (95% CI 0.66-0.88) and 0.82 (95% CI 0.77-0.93), respectively; P=0.080). For the FANTASIIA population, 46 patients had major bleeding events and 50 patients died. The predictive performances for major bleeding of HAS-BLED and ORBIT were not significantly different (c-statistics 0.63 (95% CI 0.56-0.71) and 0.70 (95% CI 0.62-0.77), respectively; P=0.116). For death, the predictive performances of HAS-BLED and ORBIT were not significantly different in both populations. The ORBIT score categorized most patients as "low risk".
  
  
  CONCLUSIONS
  Despite the original claims in its derivation paper, the ORBIT score was not superior to HAS-BLED for predicting major bleeding and death in a "real world" oral anticoagulated AF population. (Circ J 2016; 80: 2102-2108).
authors.affiliation: Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca.
authors.forename: María Asunción
authors.initials: MA
authors.lastname: Esteve-Pastor
authors.forename: Amaya
authors.initials: A
authors.lastname: García-Fernández
authors.forename: Manuel
authors.initials: M
authors.lastname: Macías
authors.forename: Francisco
authors.initials: F
authors.lastname: Sogorb
authors.forename: Mariano
authors.initials: M
authors.lastname: Valdés
authors.forename: Vanessa
authors.initials: V
authors.lastname: Roldán
authors.forename: Javier
authors.initials: J
authors.lastname: Muñiz
authors.forename: Lina
authors.initials: L
authors.lastname: Badimon
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Roldán
authors.forename: Vicente
authors.initials: V
authors.lastname: Bertomeu-Martínez
authors.forename: Ángel
authors.initials: Á
authors.lastname: Cequier
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
authors.forename: Manuel
authors.initials: M
authors.lastname: Anguita
authors.forename: Francisco
authors.initials: F
authors.lastname: Marín
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D004554:Electric Countershock / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006470:Hemorrhage / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors