Performance of five different bleeding-prediction scores in patients with acute pulmonary embolism
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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.
KeywordsBleeding Pulmonary embolism Atrial fibrillation Risk score Prevention
This study was supported by the German Federal Ministry of Education and Research (BMBF 01EO1003). FAK was supported by the Niels Stensen fellowship. The authors are responsible for the contents of this publication.
Conflict of interest
FAK, GH, CD and CN have nothing to disclose. SK declares that he has received lecture fees and advisory board honoraria from Astra Zeneca, Bayer Health Care, Boehringer Ingelheim, Pfizer-Bristol-Myers Squibb and Daiichi Sankyo. ML reports receiving lecture fees and advisory board honoraria from Bayer Health Care and Pfizer-Bristol-Myers Squibb.
Human and Animal Rights and Informed Consent
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.
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