{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T01:01:54Z","timestamp":1784595714409,"version":"3.55.0"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,1,5]],"date-time":"2023-01-05T00:00:00Z","timestamp":1672876800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The 2021 UK National Institute for Health and Care Excellence guidelines tend to recommend the ORBIT score for predicting bleeding risk in patients with atrial fibrillation (AF) with anticoagulants. Herein, we comprehensively re-assessed the predicted abilities of the HAS-BLED vs. ORBIT score since several newly published data showed different findings.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We comprehensively searched the PubMed electronic database until December 2021 to identify relevant studies reporting the ORBIT vs. HAS-BLED scores in anticoagulated patients with AF. Their predicted abilities were assessed using the C-index, reclassification, and calibration analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Finally, 17 studies were included in this review. In the pooled analysis, the ORBIT score had a C-index of 0.63 (0.60\u20130.66), 0.59 (0.53\u20130.66), and 0.57 (0.48\u20130.67) 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\u20130.63), 0.59 (0.56\u20130.63), and 0.57 (0.51\u20130.64) 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 vs. direct oral anticoagulants suggested no differences in the discrimination ability between the HAS-BLED and ORBIT scores. Reclassification and calibration analyses of HAS-BLED vs. ORBIT should be further assessed due to the limited and conflicting data.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2022.1042763","type":"journal-article","created":{"date-parts":[[2023,1,5]],"date-time":"2023-01-05T13:36:00Z","timestamp":1672925760000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":12,"title":["HAS-BLED vs. ORBIT scores in anticoagulated patients with atrial fibrillation: A systematic review and meta-analysis"],"prefix":"10.3389","volume":"9","author":[{"given":"Xuyang","family":"Liu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shengnan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenfeng","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linjuan","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,1,5]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1161\/CIRCRESAHA.120.316340","article-title":"Epidemiology of atrial fibrillation in the 21st century: novel methods and new insights.","volume":"127","author":"Kornej","year":"2020","journal-title":"Circ Res."},{"key":"B2","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1093\/eurheartj\/ehaa612","article-title":"2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European association for cardio-thoracic surgery (EACTS).","volume":"42","author":"Hindricks","year":"2021","journal-title":"Eur Heart J."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1715","DOI":"10.1111\/jth.13361","article-title":"Low performance of bleeding risk models in the very elderly with atrial fibrillation using vitamin K antagonists","volume":"14","author":"Jaspers","year":"2016","journal-title":"J Thromb Haemost"},{"key":"B4","doi-asserted-by":"publisher","first-page":"791","DOI":"10.1111\/jth.14692","article-title":"Accuracy of HAS-BLED and other bleeding risk assessment tools in predicting major bleeding events in atrial fibrillation: a network meta-analysis.","volume":"18","author":"Chang","year":"2020","journal-title":"J Thromb Haemost."},{"key":"B5","doi-asserted-by":"publisher","first-page":"2171","DOI":"10.1055\/s-0038-1675400","article-title":"Predicting thromboembolic and bleeding event risk in patients with non-valvular atrial fibrillation: a systematic review.","volume":"118","author":"Borre","year":"2018","journal-title":"Thromb Haemost."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1093","DOI":"10.1378\/chest.10-0134","article-title":"A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey.","volume":"138","author":"Pisters","year":"2010","journal-title":"Chest."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1460","DOI":"10.1111\/j.1538-7836.2011.04378.x","article-title":"Bleeding risk in \u2018real world\u2019 patients with atrial fibrillation: comparison of two established bleeding prediction schemes in a nationwide cohort.","volume":"9","author":"Olesen","year":"2011","journal-title":"J Thromb Haemost."},{"key":"B8","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1055\/s-0041-1739411","article-title":"2021 focused update consensus guidelines of the asia pacific heart rhythm society on stroke prevention in atrial fibrillation: executive summary.","volume":"122","author":"Chao","year":"2021","journal-title":"Thromb Haemost."},{"key":"B9","doi-asserted-by":"publisher","first-page":"3258","DOI":"10.1093\/eurheartj\/ehv476","article-title":"The ORBIT bleeding score: a simple bedside score to assess bleeding risk in atrial fibrillation.","volume":"36","author":"O\u2019Brien","year":"2015","journal-title":"Eur Heart J."},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2021.757087","article-title":"Diagnostic accuracy of the HAS-BLED bleeding score in VKA- or DOAC-treated patients with atrial fibrillation: a systematic review and meta-analysis.","volume":"8","author":"Gao","year":"2021","journal-title":"Front Cardiovasc Med."},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n1150","article-title":"Atrial fibrillation: diagnosis and management-summary of NICE guidance.","volume":"373","author":"Perry","year":"2021","journal-title":"BMJ."},{"key":"B12","doi-asserted-by":"publisher","first-page":"555","DOI":"10.1002\/clc.22435","article-title":"The HAS-BLED score for predicting major bleeding risk in anticoagulated patients with atrial fibrillation: a systematic review and meta-analysis","volume":"38","author":"Zhu","year":"2015","journal-title":"Clin Cardiol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"600","DOI":"10.1016\/j.amjmed.2015.10.001","article-title":"Evaluation of the HAS-BLED, ATRIA, and ORBIT bleeding risk scores in patients with atrial fibrillation taking warfarin.","volume":"129","author":"Senoo","year":"2016","journal-title":"Am J Med."},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1038\/srep24376","article-title":"Major bleeding in patients with non-valvular atrial fibrillation: impact of time in therapeutic range on contemporary bleeding risk scores.","volume":"6","author":"Proietti","year":"2016","journal-title":"Sci Rep."},{"key":"B15","doi-asserted-by":"publisher","first-page":"2102","DOI":"10.1253\/circj.CJ-16-0471","article-title":"Is the ORBIT bleeding risk score superior to the HAS-BLED score in anticoagulated atrial fibrillation patients?.","volume":"80","author":"Esteve-Pastor","year":"2016","journal-title":"Circ J."},{"key":"B16","doi-asserted-by":"publisher","first-page":"1549","DOI":"10.1016\/j.amjcard.2017.07.051","article-title":"Comparison of the CHA2DS2-VASc, CHADS2, HAS-BLED, ORBIT, and ATRIA risk scores in predicting non-vitamin K antagonist oral anticoagulants-associated bleeding in patients with atrial fibrillation.","volume":"120","author":"Yao","year":"2017","journal-title":"Am J Cardiol."},{"key":"B17","doi-asserted-by":"crossref","first-page":"878","DOI":"10.1016\/j.recesp.2016.10.029","article-title":"Comparison of bleeding risk scores in patients with nonvalvular atrial fibrillation starting direct oral anticoagulants.","volume":"70","author":"Caro Mart\u00ednez","year":"2017","journal-title":"Rev Esp Cardiol."},{"key":"B18","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-017-11683-2","article-title":"Importance of time in therapeutic range on bleeding risk prediction using clinical risk scores in patients with atrial fibrillation.","volume":"7","author":"Rivera-Caravaca","year":"2017","journal-title":"Sci Rep."},{"key":"B19","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1111\/jcpt.12634","article-title":"Evaluation of the predictive performance of bleeding risk scores in patients with non-valvular atrial fibrillation on oral anticoagulants.","volume":"43","author":"Beshir","year":"2018","journal-title":"J Clin Pharm Ther."},{"key":"B20","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1016\/j.ijcard.2017.11.025","article-title":"Major bleeding and intracranial hemorrhage risk prediction in patients with atrial fibrillation: attention to modifiable bleeding risk factors or use of a bleeding risk stratification score? A nationwide cohort study.","volume":"254","author":"Chao","year":"2018","journal-title":"Int J Cardiol."},{"key":"B21","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1016\/j.amjmed.2017.11.046","article-title":"The HAS-BLED, ATRIA, and ORBIT bleeding scores in atrial fibrillation patients using non-vitamin K antagonist oral anticoagulants.","volume":"131","author":"Lip","year":"2018","journal-title":"Am J Med."},{"key":"B22","doi-asserted-by":"publisher","first-page":"282","DOI":"10.1111\/joim.12702","article-title":"Comparison of bleeding risk scores in patients with atrial fibrillation: insights from the RE-LY trial.","volume":"283","author":"Proietti","year":"2018","journal-title":"J Intern Med."},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0203599","article-title":"A new model to predict major bleeding in patients with atrial fibrillation using warfarin or direct oral anticoagulants.","volume":"13","author":"Claxton","year":"2018","journal-title":"PLoS One."},{"key":"B24","doi-asserted-by":"crossref","DOI":"10.1136\/openhrt-2018-000931","article-title":"New score for assessing bleeding risk in patients with atrial fibrillation treated with NOACs.","volume":"5","author":"Rutherford","year":"2018","journal-title":"Open Heart."},{"key":"B25","doi-asserted-by":"publisher","first-page":"1044","DOI":"10.1016\/j.amjcard.2019.07.005","article-title":"External validation of the ORBIT bleeding score and the HAS-BLED score in nonvalvular atrial fibrillation patients using direct oral anticoagulants (Asian data from the DIRECT registry).","volume":"124","author":"Mori","year":"2019","journal-title":"Am J Cardiol."},{"key":"B26","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1111\/jth.15251","article-title":"Novel bleeding risk score for patients with atrial fibrillation on oral anticoagulants, including direct oral anticoagulants.","volume":"19","author":"Adam","year":"2021","journal-title":"J Thromb Haemost."},{"key":"B27","doi-asserted-by":"publisher","first-page":"1305","DOI":"10.1002\/clc.23688","article-title":"Comparison among random forest, logistic regression, and existing clinical risk scores for predicting outcomes in patients with atrial fibrillation: a report from the J-RHYTHM registry.","volume":"44","author":"Watanabe","year":"2021","journal-title":"Clin Cardiol."},{"key":"B28","doi-asserted-by":"publisher","first-page":"778","DOI":"10.1093\/ehjqcco\/qcab069","article-title":"Comparison of HAS-BLED and ORBIT bleeding risk scores in atrial fibrillation patients treated with non-vitamin K antagonist oral anticoagulants: a report from the ESC-EHRA EORP-AF general long-term registry.","volume":"8","author":"Proietti","year":"2021","journal-title":"Eur Heart J Qual Care Clin Outcomes."},{"key":"B29","doi-asserted-by":"publisher","first-page":"788","DOI":"10.1111\/jth.14738","article-title":"Considerations when choosing an appropriate bleeding risk assessment tool for patients with atrial fibrillation.","volume":"18","author":"Ding","year":"2020","journal-title":"J Thromb Haemost."},{"key":"B30","doi-asserted-by":"publisher","first-page":"2203","DOI":"10.1111\/bcp.15145","article-title":"Comparison of the HAS-BLED versus ORBIT scores in predicting major bleeding among Asians receiving direct-acting oral anticoagulants.","volume":"88","author":"Wattanaruengchai","year":"2022","journal-title":"Br J Clin Pharmacol."}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2022.1042763\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,5]],"date-time":"2023-01-05T13:36:09Z","timestamp":1672925769000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2022.1042763\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,5]]},"references-count":30,"alternative-id":["10.3389\/fcvm.2022.1042763"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2022.1042763","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,5]]},"article-number":"1042763"}}