. 2022 Oct 16;40(1):41–66. doi: 10.1007/s12325-022-02333-9

Table 5.

Major bleeding prediction models in AF patients

Score Author, year	Bleeding risk factors included	Risk scoring and MB annual incidence
OBRI Beyth [117], 1998	Age ≥ 65 yrs, history of GIB, previous stroke, co-morbidities (recent MI, hematocrit < 30%, diabetes, creatinine > 1.5 mg/dL): 1 pt each	Low risk: 0 = 3% at 48 months Intermediate risk: 1–2 = 12% at 48 months High-risk: 3–4 = 53% at 48 months
HEMORR₂HAGES Gage [118], 2006	Prior bleed (2 pts). Liver/renal disease, ethanol abuse, malignancy, age > 75 yrs, low platelet count or function, uncontrolled hypertension, anemia, genetic factors (CYP2C9), risk of fall, stroke (1 pt each)	Low risk: 0 = 1.9%, 1 = 2.5% Intermediate risk: 2 = 5.3%, 3 = 8.4% High risk: 4 = 10.4%, 5 = 12.3%
ATRIA Fang [119], 2011	Anemia, renal disease (eGFR < 30 ml/min): 3 pts each; age > 75 yrs: 2 pts; any prior bleeding, hypertension: 1 pt each	Low risk: 0–3 = 0.76% Intermediate risk: 4 = 2.62% High risk: 5–10 = 5.76%
HAS-BLED Pisters [120], 2010	Hypertension (uncontrolled), abnormal renal or liver function, stroke, bleeding history/predisposition, labile INR (TTR < 60%), elderly (> 65 yrs), drugs (antiplatelets/NSAIDs) or excess alcohol (1 pt each)	Low risk: 0 = 1.13% Moderate risk: 1 = 1.02%, 2 = 1.88% High-risk: 3 = 3.74%, 4 = 8.70%, 5–9 = insufficient data
ORBIT O’Brien [121], 2015	Reduced Hb (< 13 mg/dL M; < 12 mg/dL F), Ht (< 40% M, < 36% F), history of anemia and bleeding history: 2 pts each; eGFR < 60 mg/dL/1.73 m², age ≥ 75 yrs, antiplatelet agent: 1 pt each	Low risk: 0–2 = 2.4% Medium risk: 3 = 4.7% High risk: ≥ 4 = 8.1%
ABC Hijazi [122], 2016	Age, biomarkers (GDF-15, cTnT-hs, and Hb), and clinical history (previous bleeding)	Nomogram: Low risk = 0.77% High risk = 30%
NBP Barnett-Griness [123], 2022	Thrombocytopenia (< 99 × 10³/μL): 9 pts; hypertension: 8 pts; M sex, antiplatelet therapy: 7 pts each; anemia (Hb < 13 g/dL M, < 12 g/dL F): 6 pts; prior MB: 5 pts; known fall risk: 4 pts; serum CH (mg/dL): 200–239 = 1 pt, 160–199 = 2 pts, < 160 = 5 pts; eGFR (mL/min): 60–89 = 4 pts, 30–59 = 6 pts, ≤ 29 = 8 pts	Continuous variable: from 0.3% (0 points) to 10.3% (59 points)

Score
Author, year

Bleeding risk factors included

Risk scoring and MB annual incidence

OBRI

Beyth [117], 1998

Age ≥ 65 yrs, history of GIB, previous stroke, co-morbidities (recent MI, hematocrit < 30%, diabetes, creatinine > 1.5 mg/dL): 1 pt each

Low risk: 0 = 3% at 48 months

Intermediate risk: 1–2 = 12% at 48 months

High-risk: 3–4 = 53% at 48 months

HEMORR₂HAGES

Gage [118], 2006

Prior bleed (2 pts). Liver/renal disease, ethanol abuse, malignancy, age > 75 yrs, low platelet count or function, uncontrolled hypertension, anemia, genetic factors (CYP2C9), risk of fall, stroke (1 pt each)

Low risk: 0 = 1.9%, 1 = 2.5%

Intermediate risk: 2 = 5.3%, 3 = 8.4%

High risk: 4 = 10.4%, 5 = 12.3%

ATRIA

Fang [119], 2011

Anemia, renal disease (eGFR < 30 ml/min): 3 pts each; age > 75 yrs: 2 pts; any prior bleeding, hypertension: 1 pt each

Low risk: 0–3 = 0.76%

Intermediate risk: 4 = 2.62%

High risk: 5–10 = 5.76%

HAS-BLED

Pisters [120], 2010

Hypertension (uncontrolled), abnormal renal or liver function, stroke, bleeding history/predisposition, labile INR (TTR < 60%), elderly (> 65 yrs), drugs (antiplatelets/NSAIDs) or excess alcohol (1 pt each)

Low risk: 0 = 1.13%

Moderate risk: 1 = 1.02%, 2 = 1.88%

High-risk: 3 = 3.74%, 4 = 8.70%, 5–9 = insufficient data

ORBIT

O’Brien [121], 2015

Reduced Hb (< 13 mg/dL M; < 12 mg/dL F), Ht (< 40% M, < 36% F), history of anemia and bleeding history: 2 pts each; eGFR < 60 mg/dL/1.73 m², age ≥ 75 yrs, antiplatelet agent: 1 pt each

Low risk: 0–2 = 2.4%

Medium risk: 3 = 4.7%

High risk: ≥ 4 = 8.1%

ABC

Hijazi [122], 2016

Age, biomarkers (GDF-15, cTnT-hs, and Hb), and clinical history (previous bleeding)

Nomogram: Low risk = 0.77%

High risk = 30%

NBP

Barnett-Griness [123], 2022

Thrombocytopenia (< 99 × 10³/μL): 9 pts; hypertension: 8 pts; M sex, antiplatelet therapy: 7 pts each; anemia (Hb < 13 g/dL M, < 12 g/dL F): 6 pts; prior MB: 5 pts; known fall risk: 4 pts; serum CH (mg/dL): 200–239 = 1 pt, 160–199 = 2 pts, < 160 = 5 pts; eGFR (mL/min): 60–89 = 4 pts, 30–59 = 6 pts, ≤ 29 = 8 pts

Continuous variable:

from 0.3% (0 points)

to 10.3% (59 points)

CH cholesterol, cTnT-hs high-sensitivity cardiac troponin T, eGFR estimated glomerular filtration rate, F female, GDF-15 growth differentiation factor-15, GIB gastrointestinal bleeding, Hb hemoglobin, Ht hematocrit, INR international normalized ratio, M male, MB major bleeding, MI myocardial infarction, NSAIDs nonsteroidal antiinflammatory drugs, pt point, TTR time in therapeutic range, yrs years