¿La puntuación de riesgo hemorrágico ORBIT es superior a la puntuación HAS-BLED en pacientes con fibrilación auricular anticoagulados?

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 HAS-BLED 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. (Circ J 2016; 80: 2102-2108).

Resumen tomado de PubMed (NCBI) para el registro citado, en el idioma original. La versión de referencia es la de la publicación original.

El resumen se deja sin traducir para conservar la redacción original de los autores.

Se comparó el rendimiento predictivo de las puntuaciones ORBIT y HAS-BLED en 406 pacientes con fibrilación auricular sometidos a 571 cardioversiones eléctricas y en 1 276 pacientes del registro FANTASIIA. Para hemorragia mayor, los estadísticos c fueron 0,77 (HAS-BLED) frente a 0,82 (ORBIT; p = 0,080) y 0,63 frente a 0,70 (p = 0,116); tampoco hubo diferencias significativas en la predicción de mortalidad. Los autores concluyen que la puntuación ORBIT no fue superior a HAS-BLED en esta población del «mundo real».

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