Prediction of major bleeding in anticoagulated patients for venous thromboembolism: Comparison of the RIETE and the VTE-BLEED Scores

  1. Lecumberri, Ramón 6
  2. Jiménez, Laura 2
  3. Ruiz-Artacho, Pedro 6
  4. Nieto, José Antonio 2
  5. Ruiz-Giménez, Nuria 8
  6. Visonà, Adriana 5
  7. Skride, Andris 7
  8. Moustafa, Fares 4
  9. Trujillo, Javier 3
  10. Monreal, Manuel 1
  1. 1 Department of Internal Medicine, Instituto de Salud Carlos III, Universidad Católica de Murcia, Hospital Germans Trias i Pujol, CIBERES, Badalona (Barcelona), Madrid, Spain
  2. 2 Hospital Virgen de La Luz de Cuenca
    info

    Hospital Virgen de La Luz de Cuenca

    Cuenca, España

    ROR https://ror.org/00k49k182

  3. 3 Hospital General Universitario Santa Lucía
    info

    Hospital General Universitario Santa Lucía

    Cartagena, España

  4. 4 Centre Hospitalier Universitaire de Clermont-Ferrand
    info

    Centre Hospitalier Universitaire de Clermont-Ferrand

    Clermont-Ferrand, Francia

    ROR https://ror.org/02tcf7a68

  5. 5 Department of Vascular Medicine, Ospedale Castelfranco Veneto, Castelfranco Veneto, Italy
  6. 6 Clínica Universitaria de Navarra
    info

    Clínica Universitaria de Navarra

    Pamplona, España

    ROR https://ror.org/03phm3r45

  7. 7 Pauls Stradiņš Clinical University Hospital
    info

    Pauls Stradiņš Clinical University Hospital

    Riga, Letonia

    ROR https://ror.org/00h1aq868

  8. 8 Hospital Universitario de la Princesa
    info

    Hospital Universitario de la Princesa

    Madrid, España

    ROR https://ror.org/03cg5md32

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Revista:
TH Open

ISSN: 2512-9465,  2567-3459

Ano de publicación: 2021

Volume: 5

Número: 3

Páxinas: e319-e328

Tipo: Artigo

DOI: 10.1055/S-0041-1729171 GOOGLE SCHOLAR lock_openAcceso aberto editor

Outras publicacións en: TH Open

Obxectivos de Desenvolvemento Sustentable

Resumo

The performance of validated bleeding risk scores in patients with venous thromboembolism (VTE) could be different depending on the time after index event or the site of bleeding. In this study we compared the "classic" Registro Informatizado de Enfermedad TromboEmbólica (RIETE) score and the more recently developed VTE-BLEED score for the prediction of major bleeding in patients under anticoagulant therapy in different time intervals after VTE diagnosis. Out of 82,239 patients with acute VTE, the proportion of high-risk patients according to the RIETE and VTE-BLEED scores was 7.1 and 62.3%, respectively. The performance of both scores across the different study periods (first 30 days after VTE diagnosis, days 31-90, days 91-180, and days 181-360) was similar, with areas under the receiving operating characteristics (ROC) curve (AUC) ranging between 0.69 and 0.72. However, the positive predictive values were low, ranging between 0.6 and 3.9 (better for early major bleeding than for later periods). A sensitivity analysis limited to patients with unprovoked VTE showed comparable results. Both scores showed a trend toward a better prediction of extracranial than intracranial major bleeding, the RIETE score resulting more useful for early extracranial bleeding and the VTE-BLEED for late intracranial hemorrhages. Our study reveals that the usefulness of available bleeding scores may vary depending on the characteristics of the patient population and the time frame evaluated.

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