Stroke & Bleeding risk assessment Part 3

What are the learning outcomes for the ORBIT bleeding risk lecture? (4 points)

1. Describe the components of the ORBIT risk assessment tool

2. Be confident calculating the ORBIT score and understanding its significance

3. Outline strategies to reduce bleeding risk

4. Be confident explaining the bleeding risk to patients based on their ORBIT score

What is the ORBIT score and its purpose? (5 points)

1. Risk assessment tool for patients with AF on oral anticoagulation

2. Estimates likelihood of a major bleed within 12 months

3. Each letter represents a risk factor contributing to the score

4. Supports decisions about suitability for anticoagulation

5. Higher score = greater risk of major bleeding

What are the components of the ORBIT score? (5 points)

1. Older age (-75 years) = 1 point

2. Reduced haemoglobin or haematocrit = 2 points

3. History of bleeding = 2 points

4. Insufficient kidney function (eGFR <60) = 1 point

5. Treatment with antiplatelets = 1 point

Q: What limitations are associated with the ORBIT score? (7 poin

1. Does not include hypertension

2. Does not account for liver disease

3. Excludes ischaemic stroke history

4. Labile INR not included

5. Medications like SSRIs and NSAIDs excluded

6. Alcohol intake not accounted (>8 units/week)

7. Modifiable risk factors still need to be assessed clinically

How does Mr Brown score on the ORBIT tool and what does it mean? (6 points)

1. Mr Brown is 68 years old - no age point

2. No reduced haemoglobin - 0 points

3. No bleeding history - 0 points

4. eGFR = 50 (insufficient kidney function) - 1 point

5. No antiplatelet use - 0 points

6. Total ORBIT score = 1 (low bleeding risk)

What are the clinical implications of different ORBIT scores? (3 points)

1. Low (0-2): 2.4% annual risk of major bleed

2. Medium (3): 4.7% annual risk

3. High (>4): 8.1% annual risk

What does NICE recommend regarding anticoagulation and bleeding risk? (3 points)

1. Assess bleeding risk and modify risk factors where possible

2. Do not withhold anticoagulation based solely on age or falls risk

3. There is no absolute ORBIT score threshold to avoid treatment

How should pharmacists explain bleeding risk to patients? (2 points

. Final decision about anticoagulation rests with the patient

2. Pharmacists should clearly explain both stroke and bleeding risks to support informed decisions