AUTHOR=Liu Xuyang , Wang Shengnan , He Wenfeng , Guo Linjuan 

TITLE=HAS-BLED vs. ORBIT scores in anticoagulated patients with atrial fibrillation: A systematic review and meta-analysis

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2023

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.1042763

DOI=10.3389/fcvm.2022.1042763

ISSN=2297-055X

ABSTRACT=Background: The 2021 UK National Institute for Health and Care Excellence guidelines tend to recommend the ORBIT score for predicting bleeding risk in AF patients with anticoagulants. Herein, we comprehensively re-assessed the predicted abilities of the HAS-BLED versus ORBIT score since several newly published data showed different findings. 
Methods: We comprehensively searched the PubMed electronic database until December 2021 to identify relevant studies reporting the ORBIT versus HAS-BLED scores in anticoagulated patients with AF. Their predicted abilities were assessed using the C-index, reclassification, and calibration analysis.
Results: We included 17 studies in this review finally. In the pooled analysis, the ORBIT score had a C-index of 0.63 (0.60-0.66), 0.59 (0.53-0.66), and 0.57 (0.48-0.67) for major bleeding, any clinically relevant bleeding, and intracranial bleeding, respectively, while the HAS-BLED score had a C-index of 0.61 (0.59-0.63), 0.59 (0.56-0.63), and 0.57 (0.51-0.64) for major bleeding, any clinically relevant bleeding, and intracranial bleeding, respectively. There were no statistical differences in the accuracy of predicting these bleeding events between the two scoring systems. For the outcome of major bleeding, the subgroup analyses based on vitamin K antagonists versus direct oral anticoagulants suggested no differences in the discrimination ability between the HAS-BLED versus ORBIT scores. Reclassification and calibration analyses of HAS-BLED versus ORBIT should be further assessed due to the limited and conflicting data.
Conclusions: Our current findings suggested that the HAS-BLED and ORBIT scores at least had similar predictive abilities for major bleeding risk in anticoagulated (vitamin K antagonists or direct oral anticoagulants) patients with AF, supporting the use of the HAS-BLED score in clinical practice.