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    ORBIT Bleeding Risk Score for Atrial Fibrillation

    Predicts bleeding risk in patients on anticoagulation for afib, similar to HAS-BLED.
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    INSTRUCTIONS

    Use in adult patients with atrial fibrillation, to assess risk of major bleeding with anticoagulation.

    When to Use
    Pearls/Pitfalls
    Why Use

    Patients with atrial fibrillation in whom anticoagulation is being considered for stroke prevention.

    • Major bleeding was defined as fatal bleeding, symptomatic bleeding in a critical organ, or bleeding with a hemoglobin drop requiring transfusion of ≥2 units (ISTH criteria).

    • ORBIT does not take into account choice of anticoagulant. 

    • Unlike HAS-BLED, ORBIT does not take into account the time in therapeutic range, as there is no reliable or readily available objective measure for therapeutic range of the direct oral anticoagulants (DOACs).

    • Unlike HAS-BLED, ORBIT was derived in a patient population that included vitamin K antagonists (VKAs, such as warfarin) as well as DOACs.

    • May be used in conjunction with the CHA₂DS₂-Vasc Score to risk stratify patients for clinically significant bleeding to help guide decisions on anticoagulation in patients with atrial fibrillation.

    • May not be statistically superior to HAS-BLED (see Evidence for details), but was more recently derived and validated in the era of DOACs, and may be more useful for that reason.

    Male
    Female
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    Yes
    +1
    No
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    No
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    Result:

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    Next Steps
    Evidence
    Creator Insights

    Critical Actions

    Other risk factors not part of the ORBIT Score may influence the decision for anticoagulation. Patient preferences and values should go into the decision regarding anticoagulation as it pertains to risks vs benefits of being on anticoagulation for stroke prevention in patients with atrial fibrillation.

    Content Contributors
    Reviewed By
    • Jeffrey Marbach, MBBS, MS, FRCPC
    About the Creator
    Dr. Emily C. O’Brien
    Are you Dr. Emily C. O’Brien?
    Content Contributors
    Reviewed By
    • Jeffrey Marbach, MBBS, MS, FRCPC