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CHICAGO -- A general bleeding-risk scoring system was effective at predicting whether patients with a history of gastrointestinal bleeds would suffer new events in the small bowel while taking anticoagulants, a researcher said here.

Patients in a single-center retrospective analysis with high scores on the ORBIT scale -- first developed to -- showed substantially greater rates of rebleeds in the small bowel during follow-up of at least 6 months, said T. Cúrdia Gonçalves, MD, of Hospital da Senhora da Oliveira in Guimarães, Portugal.

Rebleeding was seen in 80% of patients with scores of at least 4 on ORBIT's 7-point scale, Gonçalves said at Digestive Disease Week 2017, compared with 37% in those scored as low or intermediate risk (P=0.003).

But ORBIT was less successful in predicting which patients would show small-bowel lesions on capsule endoscopy that could become future bleeding sites, Gonçalves said. There were no significant differences in diagnostic yields among the ORBIT-scored risk groups, and actually the high-risk group had the lowest rate of such lesions.

ORBIT is an acronym for the five components contributing to the score (ORBIT also happens to be the name of the registry that supplied the original data validating the system):

• Older age (75 or greater)
• Reduced hemoglobin/hematocrit
• Bleeding history
• Insufficient kidney function
• Treatment with antiplatelets

Anemia and bleeding history are scored at two points each; the other components each get one.

Gonçalves noted that other bleeding-risk predictors have been developed, including HAS-BLED, HEMORR₂AGES, and ATRIA, but these have not done very well at specifically assessing risk for GI bleeding. His group thought it would be valuable to examine ORBIT, as a simple tool using standard clinical parameters.

They examined records of 570 patients with suspected small-bowel bleeding seen from 2006 to 2016, focusing on 67 who were chronically taking anticoagulants. Mean patient age was 74 and about 64% were women. Three-quarters were taking anticoagulents for Afib, with another 18% using them in conjunction with mechanical valves. Some 80% were evaluated for occult obscure bleeding, with the remainder showing overt GI bleeds.

By far the most common anticoagulant medication in the group was warfarin (81%), followed by low molecular weight heparin and other agents.

Capsule endoscopy in the small bowel revealed about equal numbers of P1 and P2 lesions and findings of no lesions in the patients. Only three patients had P0 lesions.

ORBIT scores of 4 or more were calculated for 26 of the patients; the remaining 41 were lumped together as low and intermediate for the analysis; Gonçalves showed a histogram indicating the largest numbers of patients scoring 2, 3, and 4.

The study's clinical implication, he said, is that ORBIT could be useful in patients who have developed small bowel bleeding: those with high scores should be monitored closely for additional bleeding episodes.

Gonçalves also said it was notable that, in the study, more than 10% of patients on chronic anticoagulation at the center were referred for capsule endoscopy of the small bowel, suggesting that the risk of such bleeding "is not negligible."

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