Comparison of the HAS-BLED versus ORBIT Scores in Predicting Major Bleeding Among Asians Receiving the Direct-Acting Oral Anticoagulants.

AIMS This study aimed to evaluate the performance of HAS-BLED and ORBIT scores in predicting bleeding risk among Asian patients with non-valvular atrial fibrillation (NVAF) using the direct-acting oral anticoagulant (DOACs). METHODS A retrospective chart review was conducted among adult patients receiving DOACs for > 6 months during January 2013 - December 2017 in 10 tertiary care hospitals in Thailand. The area under the receiver-operating curve (AUROC) method or C-statistic was used to test the diagnostic accuracy for bleeding risk classification of HAS-BLED and ORBIT scores. The predictive performances of the two scores were compared using DeLong's method. RESULTS A total of 961 NVAF patients, 52.5% warfarin-naive and 47.5% warfarin-experienced, with mean age of 74.25±10.08 years, were included in the analysis. Mean HAS-BLED and ORBIT scores of the cohort were 1.98±1.10 and 2.37±1.71, respectively. During the mean follow-up time of 1.55+1.13 years, 34 patients experienced major bleeding (2.28 events/100 patient-year). For the overall cohort, both the HAS-BLED and ORBIT scores showed similarly moderate predictive performance on bleeding with C-statistic (95%CI) of 0.65 (0.57-0.74) and 0.64 (0.56-0.71), respectively. There was no statistical significance between the two scores (p = 0.62). Analysis based on the status of previous warfarin use was consistent with the overall cohort. Based on the calibration analysis, both HAS-BLED and ORBIT scores possessed moderate ability to identify those who experienced major bleeding from those who did not. CONCLUSION Both HAS-BLED and ORBIT bleeding risk scores had moderate predictive performance in Asian NVAF patients receiving DOACs.