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Eur J Intern Med. 2014 Feb;25(2):137-41. doi: 10.1016/j.ejim.2013.10.004. Epub 2013 Nov 4.

Bleeding and venous thromboembolism arising in acutely ill hospitalized medical patients. Findings from the Spanish national discharge database.

Author information

1
Department of Internal Medicine, Hospital Carlos Haya, Málaga, Spain.
2
Department of Internal Medicine, Hospital de la Axarquía, Vélez-Málaga, Spain.
3
Department of Surgery, Universidad de Granada and Hospital Virgen de las Nieves, Granada, Spain.
4
Department of Internal Medicine, Complejo Hospitalario Universitario de Vigo, Spain.
5
Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Spain. Electronic address: mmonreal.germanstrias@gencat.cat.

Abstract

BACKGROUND:

There is scarce evidence to identify which acutely ill medical patients might benefit from prophylaxis against venous thromboembolism (VTE).

METHODS:

The Spanish National Discharge Database was used to identify predictors of bleeding and VTE during hospitalization for an acute medical illness.

RESULTS:

Of 1,148,301 patients, 3.10% bled, 1.21% were diagnosed with VTE, and 8.64% died. The case-fatality rate was: 20.8% for bleeding and 19.7% for VTE. Eight clinical variables were independently associated with an increased risk for VTE and bleeding, one with a decreased risk for both events, 4 with an increased risk for VTE and a decreased risk for bleeding, 2 with an increased risk for bleeding but a decreased risk for VTE, and 1 with a decreased risk for bleeding. When all these variables were considered, we composed a risk scoring system, in which we assigned points to each variable according to the ratio between the odds ratio for bleeding and for VTE. Overall, 21% of patients scored less than 0 points and had a bleeding vs. VTE ratio of 1.19; 55% scored 0 to 1.0 points and had a ratio of 2.13; and 24% scored over 1.0 points and had a ratio of 6.10.

CONCLUSIONS:

A risk score based on variables documented at admission can identify patients with different ratios (near 1.0; about 2.0; and >6.0) between the rate of bleeding and of VTE.

KEYWORDS:

Bleeding; Medical patients; Scoring; Venous thromboembolism

PMID:
24200547
DOI:
10.1016/j.ejim.2013.10.004
[Indexed for MEDLINE]

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