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J Thromb Thrombolysis. 2016 Feb;41(2):312-20. doi: 10.1007/s11239-015-1239-x.

Performance of five different bleeding-prediction scores in patients with acute pulmonary embolism.

Author information

1
Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Johannes Gutenberg University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.
2
Clinic for Cardiology and Pulmonology, Heart Center, University of Göttingen, Göttingen, Germany.
3
Department of Paediatric Cardiology, Heart Center, University of Göttingen, Göttingen, Germany.
4
Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Johannes Gutenberg University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany. mareike.lankeit@unimedizin-mainz.de.
5
Clinic for Cardiology and Pulmonology, Heart Center, University of Göttingen, Göttingen, Germany. mareike.lankeit@unimedizin-mainz.de.

Abstract

Bleeding-prediction scores may help guiding management of patients with pulmonary embolism (PE), although no such score has been validated. We aimed to externally validate and compare two bleeding-prediction scores for venous thromboembolism to three scores developed for patients with atrial fibrillation in a real-world cohort of PE patients. We performed a prospective observational cohort study in 448 consecutive PE patients who were treated with heparins followed by vitamin-K-antagonists. The Kuijer, RIETE, HEMORR2HAGES, HAS-BLED and ATRIA scores were assessed at baseline. All patients were followed for the occurrence of major bleeding over a 30-day period. The accuracies of both the overall, original 3-level and newly defined optimal 2-level outcome of the scores were evaluated and compared, both for the 30-day period as well as for bleeding occurring in versus after the first week of treatment. 20 of 448 patients suffered major bleeding resulting in a cumulative incidence of 4.5 % (95 % CI 2.5-6.5). The predictive power of all five scores for bleeding was poor (c-statistics 0.57-0.64), both for the 3-level and 2-level score outcomes. No individual score was found to be superior. The HAS-BLED score had a good c-statistic for bleedings occurring after the first week of treatment (0.75, 95 % CI 0.47-1.0). Current available scoring systems have insufficient accuracy to predict overall anticoagulation-associated bleeding in patients treated for acute PE. To optimally target bleeding-prevention strategies, the development of a high quality PE-specific risk score is urgently needed.

KEYWORDS:

Atrial fibrillation; Bleeding; Prevention; Pulmonary embolism; Risk score

PMID:
26091712
DOI:
10.1007/s11239-015-1239-x
[Indexed for MEDLINE]

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