ORBIT versus HAS-BLED scores in predicting major bleeding in patients with atrial fibrillation receiving oral anticoagulants

Atrial fibrillation (AF) is marked by irregular and often rapid heartbeats and is closely tied to various cardiovascular diseases. This study set out to examine and compare bleeding events in AF patients receiving oral anticoagulants at Sohag University Hospital, using bleeding risk scores such as HAS-BLED alongside the ORBIT registry for better-informed treatment choices.Methods: A total of 100 patients with valvular heart disease or heart valve replacement, who were receiving anticoagulants for non-valvular atrial fibrillation (AF) and had a CHA2DS2-VASc score of 2 or higher, participated in this prospective observational comparative study. The goal of the study was to assess bleeding events using the HAS-BLED and ORBIT bleeding risk scores in patients treated with either warfarin or NOACs.Results: A moderate risk of bleeding was prevalent among most patients, as reflected by median ORBIT and HAS-BLED scores of 3 (range 2-3). Both scores effectively predicted major bleeding (P < 0.001), with area under the curve values of 0.734 for ORBIT and 0.845 for HAS-BLED. At a cutoff of >2, ORBIT demonstrated sensitivity of 64.79%, specificity of 72.41%, positive predictive value of 85.2%, and negative predictive value of 45.7%, while HAS-BLED showed 69.01% sensitivity, 79.31% specificity, 89.1% positive predictive value, and 51.1% negative predictive value.Conclusions: In patients with atrial fibrillation (AF) treated with direct oral anticoagulants, both the HAS-BLED and ORBIT bleeding risk scores show moderate predictive power for bleeding. However, the HAS-BLED score excels over the ORBIT score when predicting significant bleeding, with better sensitivity and specificity.