Abstract 18832: The ORBIT-AF Bleeding Score: a Simple Score to Assess Major Bleeding Risk in Atrial Fibrillation
Introduction: Therapeutic decisions in atrial fibrillation (AF) are often influenced by assessment of bleeding risk. Existing bleeding risk scores, however, have shown inconsistent performance and require data elements which are not readily accessible. We constructed a novel risk score using routinely available clinical information to predict the occurrence of major bleeding in a large AF population in community practice.
Methods: We used data from ORBIT-AF, a prospective registry that enrolled incident and prevalent AF patients at 176 U.S. sites, to identify risk factors for major bleeding among those taking oral anticoagulants (OAC). Major bleeding was defined according to International Society on Thrombosis and Haemostasis (ISTH) criteria. Candidate model variables were chosen based on existing evidence and clinical relevance. We created a simple risk score based on 7 factors with the largest F statistic. Point values were assigned to each predictor according to its strength of association with major bleeding. We assessed predictive performance at 1 and 2 years of followup using the C-index.
Results: Overall, 7411 AF patients in ORBIT-AF were taking OAC at baseline and had available followup data (median age: 75 years [IQR 68 - 82]; 42.4% female). Over two years of followup, major bleeding events occurred in 581 patients (7.8%). The ORBIT-AF Risk Score included: Older than 74, Renal insufficiency (eGFR<60), Bone quality (history of osteoporosis or hip fracture), Intestinal or GI bleeding history, Treatment with Antiplatelet, Anemia, and Failure (history of heart failure). The observed major bleeding rate increased with increasing risk score categories (Table 1). The predictive performance of the ORBIT-AF score was similar for 1-year and 2-year major bleeding (C-index = 0.67).
Conclusions: The ORBIT-AF bleeding risk score is a simple tool using readily available data to support clinical decision making through bleeding risk assessment.
Author Disclosures: E.C. O’Brien: None. D.N. Simon: None. D.E. Singer: Research Grant; Significant; Johnson and Johnson. Consultant/Advisory Board; Modest; Bayer HealthCare, Boehringer Ingelheim, Bristol-Myers Squibb, Johnson and Johnson, Pfizer. Consultant/Advisory Board; Significant; Daiichi Sankyo. L. Thomas: None. E.M. Hylek: Speakers Bureau; Modest; Boehringer-Ingelheim, Bayer. Consultant/Advisory Board; Modest; Johnson & Johnson, Boehringer-Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, Pfizer, Ortho-McNeil-Janssen. B.J. Gersh: Consultant/Advisory Board; Modest; Boston Scientific and St. Jude Medical. J.E. Ansell: Consultant/Advisory Board; Modest; Bristol Myers Squibb, Pfizer, Janssen, Daiichi, Boehringer Ingelheim, Alere. P.R. Kowey: Consultant/Advisory Board; Modest; Boehringer Ingelheim, Bristol Myers Squibb, Johnson & Johnson, Portola, Merck, Sanofi, Daiichi Sankyo. K.W. Mahaffey: Research Grant; Modest; AstraZeneca, Amgen, Bayer, Boehringer-Ingleheim, Bristol-Myers-Squibb, Daiichi Sankyo, Eli Lilly, GlaxoSmithKline, Johnson & Johnson, Merck, Novartis, Portola, POZEN Pharmaceutical, Schering-Plough. Consultant/Advisory Board; Modest; Amgen, AstraZeneca, Glaxo SmithKline, Johnson & Johnson, and Merck. P. Chang: Employment; Significant; Employee of Janssen Scientific Affairs. G.C. Fonarow: Consultant/Advisory Board; Modest; Ortho McNeil. E.D. Peterson: Research Grant; Significant; Eli Lilly & Company and Janssen. J.P. Piccini: Other Research Support; Significant; Boston Scientific Corporation and Janssen. Consultant/Advisory Board; Modest; Forest Laboratories, Janssen, and Medtronic.
- © 2014 by American Heart Association, Inc.