Prediction of the risk of bleeding during anticoagulant treatment for venous thromboembolism

被引:323
作者
Kuijer, PMM
Hutten, BA
Prins, MH
Büller, HR
机构
[1] Univ Amsterdam, Acad Med Ctr, Ctr Hemostas Thrombos Atheroscleros & Inflamm Res, NL-1105 AZ Amsterdam, Netherlands
[2] Univ Amsterdam, Acad Med Ctr, Dept Clin Epidemiol & Biostat, NL-1105 AZ Amsterdam, Netherlands
关键词
D O I
10.1001/archinte.159.5.457
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives: To construct and validate the bleeding risk prediction score, which is based on variables identified in the literature that can be easily obtained before the institution of anticoagulant therapy, ina large independent cohort of patients who were treated with anticoagulant therapy for established venous thromboembolism to allow for quantitative assessment of the risks and benefits of the therapy and to adapt the patient's management accordingly. Methods: We constructed a bleeding risk prediction score, based on variables and their odds ratios identified in the literature, which can be easily obtained before the institution of anticoagulant therapy (score = [1.6 x age] + [1.3 x sex] + [2.2 X malignancy]). Subsequently, we evaluated the score in a test group of 241 patients treated with anticoagulant therapy for venous thromboembolism to determine the optimal cutoff points for the prediction of hemorrhagic complications, using receiver operating characteristic curve analysis. We then validated this score in an independent cohort of 780 patients. A score of 3 or more points, 1 to 3 points, or 0 points represented a high, intermediate, or low bleeding risk, respectively. Results: The score in about one fifth of the patients in the test group was classified as predicting high risk for bleeding complications. The risk of all bleeding complications was 26% in this group and the risk of major bleeding complications was 14%. The area under the curve was 0.75 (95% confidence interval, 0.64-0.84) and 0.82 (95% confidence interval, 0.66-0.98) for all bleeding complications and major bleeding complications, respectively. When validated, there was a moderate loss of predictive power of the score, but the categorization of the patients by the score remained clinically useful; 20% of the patients were classified as high risk, and the bleeding rate was 17% for all bleeding complications and 7% for major bleeding complications compared with 4% and 1%, respectively, in those categorized as low risk. Conclusions: With the use of 3 easily obtainable, clinical variables in a prediction model, it is possible to identify a subgroup of patients at the start of anticoagulant therapy who have a high risk of developing hemorrhagic complications. Further studies should address whether additional measures to prevent bleeding decrease the bleeding incidence without compromising efficacy.
引用
收藏
页码:457 / 460
页数:4
相关论文
共 17 条
[1]  
Chesebro JH, 1996, ARCH INTERN MED, V156, P409
[2]   RISK-FACTORS FOR COMPLICATIONS OF CHRONIC ANTICOAGULATION - A MULTICENTER STUDY [J].
FIHN, SD ;
MCDONELL, M ;
MARTIN, D ;
HENIKOFF, J ;
VERMES, D ;
KENT, D ;
WHITE, RH .
ANNALS OF INTERNAL MEDICINE, 1993, 118 (07) :511-520
[3]   BLEEDING AND THROMBOEMBOLISM DURING ANTICOAGULANT-THERAPY - A POPULATION-BASED STUDY IN ROCHESTER, MINNESOTA [J].
GITTER, MJ ;
JAEGER, TM ;
PETTERSON, TM ;
GERSH, BJ ;
SILVERSTEIN, MD .
MAYO CLINIC PROCEEDINGS, 1995, 70 (08) :725-733
[4]   A METHOD OF COMPARING THE AREAS UNDER RECEIVER OPERATING CHARACTERISTIC CURVES DERIVED FROM THE SAME CASES [J].
HANLEY, JA ;
MCNEIL, BJ .
RADIOLOGY, 1983, 148 (03) :839-843
[5]  
HIRSH J, 1995, CHEST S, V108, P231
[6]   A BLEEDING RISK INDEX FOR ESTIMATING THE PROBABILITY OF MAJOR BLEEDING IN HOSPITALIZED-PATIENTS STARTING ANTICOAGULANT-THERAPY [J].
LANDEFELD, CS ;
MCGUIRE, E ;
ROSENBLATT, MW .
AMERICAN JOURNAL OF MEDICINE, 1990, 89 (05) :569-578
[7]   IDENTIFICATION AND PRELIMINARY VALIDATION OF PREDICTORS OF MAJOR BLEEDING IN HOSPITALIZED-PATIENTS STARTING ANTICOAGULANT-THERAPY [J].
LANDEFELD, CS ;
COOK, EF ;
FLATLEY, M ;
WEISBERG, M ;
GOLDMAN, L .
AMERICAN JOURNAL OF MEDICINE, 1987, 82 (04) :703-713
[8]  
LANDEFELD CS, 1989, AM J MED, V87, P144
[9]   ANTICOAGULANT-RELATED BLEEDING - CLINICAL EPIDEMIOLOGY, PREDICTION, AND PREVENTION [J].
LANDEFELD, CS ;
BEYTH, RJ .
AMERICAN JOURNAL OF MEDICINE, 1993, 95 (03) :315-328
[10]  
LEVINE MN, 1995, CHEST S, V108, P276