Is the ORBIT Bleeding Risk Score Superior to the HAS-BLED Score in Anticoagulated Atrial Fibrillation Patients?
Is the ORBIT Bleeding Risk Score Superior to the HAS-BLED Score in Anticoagulated Atrial Fibrillation Patients?
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DOI：
10.1253/circj.cj-16-0471
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发表时间：
2016-10-01
影响因子：
3.3
通讯作者：
Marin, Francisco
中科院分区：
文献类型：
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作者：
Asuncion Esteve-Pastor, Maria;Garcia-Fernandez, Amaya;Marin, Francisco
背景：几种出血风险评分已在房颤（AF）患者中得到验证。ORBIT评分最近被提出作为一种简单的评分，具有预测大出血的最佳能力。本研究的目的是检验假设，即ORBIT评分是上级的HAS-BLED评分预测大出血和死亡的"真实的世界"抗凝AF patients.Methods和Results：我们分析了出血和死亡的预测性能的406例AF患者进行了571电复律程序和1,276例永久性/持续性AF从FANTASIA注册。在心脏复律人群中，21例患者发生大出血事件，26例患者死亡。HAS-BLED和ORBIT对大出血的预测性能无显著差异（c-统计量分别为0.77（95% CI 0.66 - 0.88）和0.82（95% CI 0.77 - 0.93）; P = 0.080）。对于FANTASIIA人群，46例患者发生大出血事件，50例患者死亡。HASBLED和ORBIT对大出血的预测性能无显著差异（c-统计量分别为0.63（95% CI 0.56 - 0.71）和0.70（95% CI 0.62 - 0.77）; P = 0.116）。对于死亡，HAS-BLED和ORBIT的预测性能在两个人群中没有显著差异。ORBIT评分将大多数患者归类为“低风险”。结论：尽管其衍生论文中最初有这样的说法，但在预测“现实世界”口服抗凝剂AF人群中的大出血和死亡方面，ORBIT评分并不优于HAS-BLED。
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.Methods and 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 HASBLED 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.