ORBI Risk Score for Bleeding After Primary PCI in STEMI
Observatoire Regional Breton sur l Infarctus (ORBI) score predicts major bleeding risk after primary percutaneous coronary intervention (PPCI) for STEMI, to guide antiplatelet and anticoagulant therapy decisions.
Score interpretation
ORBI 0-1 -- low major bleeding risk; standard intensive antithrombotic therapy appropriate
→ Standard PPCI antithrombotic regimen: aspirin 300 mg loading + ticagrelor 180 mg loading (preferred over prasugrel 60 mg if < 75 years, not prior stroke/TIA, weight > 60 kg); UFH 60-100 IU/kg IV bolus intraprocedurally; bivalirudin as alternative; GPI (eptifibatide/tirofiban) if large thrombus burden or no-reflow; dual antiplatelet (DAPT): aspirin 75 mg OD + ticagrelor 90 mg BD for 12 months; radial access preferred to reduce access site bleeding; proton pump inhibitor (PPI) with DAPT.
ORBI 2-3 -- moderate bleeding risk; balance ischaemic vs haemorrhagic risk
→ Radial artery access mandatory; bivalirudin preferred over UFH if prior stroke/TIA; clopidogrel may be preferred over ticagrelor if age >= 75 (TRITON-TIMI 38: prasugrel contraindicated if prior stroke/TIA, age >= 75, weight <= 60 kg); DAPT for 12 months standard; ARC-HBR criteria check (if meets >= 1 major or >= 2 minor criteria: shorten DAPT to 1-3 months then aspirin monotherapy); monitor Hb at 24-48 hours; PPI prescribed routinely.
ORBI >= 4 -- high major bleeding risk; modified antithrombotic approach required
→ ARC-HBR criteria formal assessment; if ARC-HBR positive: abbreviated DAPT (1-3 months ticagrelor/clopidogrel then aspirin monotherapy or P2Y12 monotherapy with clopidogrel); clopidogrel preferred over ticagrelor/prasugrel in very high bleeding risk; radial access mandatory; bivalirudin intra-procedurally (HORIZONS-AMI: lower bleeding than UFH+GPI); avoid GPI unless no-reflow; haemoglobin monitoring; transfusion threshold: Hb < 8 g/dL (< 10 g/dL if haemodynamically unstable); document bleeding risk in discharge summary; haematology review if on OAC (triple therapy assessment -- AUGUSTUS, ENTRUST-AF PCI).
Interpretation bands for the ORBI Score. Apply clinical judgement and local guidance.
References
- Puymirat E et al. The ORBI risk score to predict major bleeding events after primary percutaneous coronary intervention. JACC Cardiovascular Interventions. 2015;8(8):1064-1072.
- Ibanez B et al. 2017 ESC Guidelines for management of acute myocardial infarction in ST-segment elevation. Eur Heart J. 2018;39(2):119-177.
Related
Curated clinical cross-links plus same-class fallbacks.
- Colchicine (Pericarditis / Post-MI Inflammation) · Pericarditis / Coronary Inflammation
- Alteplase (STEMI Thrombolysis) · Thrombolytic / STEMI
- Streptokinase (STEMI Thrombolysis) · Thrombolytic / STEMI
- Glyceryl Trinitrate (Sublingual / IV) · Nitrate / Acute Angina
- Dobutamine (Acute HF / Stress Echo) · Inotrope / Acute Heart Failure
- Milrinone · Inodilator / Acute Heart Failure
- Acute Heart Failure · ESC 2021 Heart Failure Guidelines; NICE NG106
- NSTEMI / Unstable Angina · ESC 2020 NSTEMI Guidelines; NICE NG185
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.