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Prospective, multicenter validation of prediction scores for major bleeding in elderly patients with venous thromboembolism


Scherz, Nathalie; Méan, Marie; Limacher, Andreas; Righini, Marc; Jaeger, Kurt; Beer, Hans-Jürg; Frauchiger, Beat; Osterwalder, Joseph; Kucher, Nils; Matter, Christian M; Banyai, Martin; Angelillo-Scherrer, Anne; Lämmle, Bernhard; Husmann, Marc; Egloff, Michael; Aschwanden, Markus; Bounameaux, Henri; Cornuz, Jacques; Rodondi, Nicolas; Aujesky, Drahomir (2013). Prospective, multicenter validation of prediction scores for major bleeding in elderly patients with venous thromboembolism. Journal of Thrombosis and Haemostasis, 11(3):435-443.

Abstract

BACKGROUND: The Outpatient Bleeding Risk Index (OBRI) and the Kuijer, RIETE, and Kearon scores are clinical prognostic scores for bleeding in patients receiving oral anticoagulants for venous thromboembolism (VTE). We prospectively compared the performance of these scores in elderly patients with VTE. METHODS: In a prospective multicenter Swiss cohort study, we studied 663 patients aged ≥65 years with acute VTE. The outcome was a first major bleeding at 90 days. We classified patients into three categories of bleeding risk (low, intermediate, and high) according to each score and dichotomized patients as high vs. low or intermediate risk. We calculated the area under the receiver operating characteristic (ROC) curve, positive predictive values and likelihood ratios for each score. RESULTS: Overall, 28 out of 663 patients (4.2%, 95% confidence interval 2.8-6.0%) had a first major bleeding within 90 days. According to different scores, the rate of major bleeding varied from 1.9% to 2.1% in low-risk, from 4.2% to 5.0% in intermediate-risk, and from 3.1% to 6.6% in high-risk patients. The discriminative power of the scores was poor to moderate, with areas under the ROC curve ranging from 0.49 to 0.60 (P=0.21). The positive predictive values and positive likelihood ratios were low and varied from 3.1% to 6.6% and from 0.72 to 1.59, respectively. CONCLUSION: In elderly patients with VTE, existing bleeding risk scores do not have sufficient accuracy and power to discriminate between patients with VTE who are at high-risk of short-term major bleeding and those who are not. © 2012 International Society on Thrombosis and Haemostasis.

Abstract

BACKGROUND: The Outpatient Bleeding Risk Index (OBRI) and the Kuijer, RIETE, and Kearon scores are clinical prognostic scores for bleeding in patients receiving oral anticoagulants for venous thromboembolism (VTE). We prospectively compared the performance of these scores in elderly patients with VTE. METHODS: In a prospective multicenter Swiss cohort study, we studied 663 patients aged ≥65 years with acute VTE. The outcome was a first major bleeding at 90 days. We classified patients into three categories of bleeding risk (low, intermediate, and high) according to each score and dichotomized patients as high vs. low or intermediate risk. We calculated the area under the receiver operating characteristic (ROC) curve, positive predictive values and likelihood ratios for each score. RESULTS: Overall, 28 out of 663 patients (4.2%, 95% confidence interval 2.8-6.0%) had a first major bleeding within 90 days. According to different scores, the rate of major bleeding varied from 1.9% to 2.1% in low-risk, from 4.2% to 5.0% in intermediate-risk, and from 3.1% to 6.6% in high-risk patients. The discriminative power of the scores was poor to moderate, with areas under the ROC curve ranging from 0.49 to 0.60 (P=0.21). The positive predictive values and positive likelihood ratios were low and varied from 3.1% to 6.6% and from 0.72 to 1.59, respectively. CONCLUSION: In elderly patients with VTE, existing bleeding risk scores do not have sufficient accuracy and power to discriminate between patients with VTE who are at high-risk of short-term major bleeding and those who are not. © 2012 International Society on Thrombosis and Haemostasis.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Angiology
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2013
Deposited On:03 Feb 2014 13:50
Last Modified:05 Apr 2016 16:32
Publisher:Wiley-Blackwell
ISSN:1538-7836
Publisher DOI:https://doi.org/10.1111/jth.12111
PubMed ID:23279158

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