Key result
HEMORR2HAGES and ORBIT predict major DOAC bleeding in AF, with HEMORR2HAGES linked to ~54% higher risk.
Why the study?
Hemorrhagic complications remain a major clinical challenge in AF patients receiving DOACs, requiring evaluation of risk assessment models to forecast bleeding incidents.
Do ORBIT, ATRIA, and HEMORR2HAGES risk scores accurately predict bleeding events in atrial fibrillation patients on DOACs?
Cohort (n=447)
Do ORBIT, ATRIA, and HEMORR2HAGES risk scores accurately predict bleeding events in atrial fibrillation patients on DOACs?
Odds Ratio: 1.535 (95% CI 1.131–2.082)
p-value: p=0.006
ORBIT and HEMORR2HAGES risk scores are valuable independent predictors of bleeding complications in AF patients treated with DOACs in a real-world setting.
Prior bleeding history signals elevated DOAC bleeding risk in AF; leaves open whether existing scores require recalibration in real-world cohorts.
Objective: Hemorrhagic complications continue to be a major clinical challenge among individuals with atrial fibrillation (AF) receiving direct-acting oral anticoagulants (DOACs). This research sought to evaluate and contrast the accuracy of various risk assessment models in forecasting bleeding incidents within this specific patient cohort. Methods: We enrolled 447 subjects diagnosed with AF who were prescribed DOAC therapy (including apixaban, dabigatran, edoxaban, or rivaroxaban). By retrospectively reviewing institutional electronic health records, we computed the ORBIT, ATRIA, and HEMORR 2 HAGES risk indices for each participant. The main outcome measures were defined as the occurrence of clinically relevant minor or major hemorrhages. Consequently, we analyzed how accurately these scoring systems could foresee the specified endpoints. Results: The cohort’s average age stood at 75.6±10.1 years, comprising predominantly women (62.2%). During a 12-month observation period, 6.7% of the participants (n=30) encountered one or more major hemorrhagic events. When forecasting severe bleeding, the ATRIA, ORBIT, and HEMORR 2 HAGES frameworks exhibited comparable predictive accuracies without any statistically notable variations. Upon conducting a multivariate logistic regression, independent variables linked to a heightened likelihood of bleeding encompassed prior hemorrhagic episodes (odds ratio [OR]: 3.101, p=0.019) and the presence of heart failure (OR: 2.028, p=0.009). In addition, anemia emerged as a significant factor (OR: 0.366, p=0.049), alongside elevated evaluations in both the HEMORR 2 HAGES (OR: 1.535, p=0.006) and ORBIT (OR: 1.849, p<0.014) scales. Conclusion: Both the ORBIT and HEMORR 2 HAGES models proved to be valuable independent indicators for future hemorrhagic complications. Integrating these tools into routine cardiovascular care can optimize therapeutic strategies and enhance the overall safety of AF patients on anticoagulation.
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İnci et al. (2026) conducted a cohort in Atrial fibrillation (n=447). HEMORR2HAGES score vs. Lower score was evaluated on Major bleeding (OR 1.535, 95% CI 1.131-2.082, p=0.006). The HEMORR2HAGES and ORBIT risk scores were significant independent predictors of major bleeding in atrial fibrillation patients receiving direct-acting oral anticoagulants, with higher HEMORR2HAGES scores associated with increased bleeding risk (OR 1.535).
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