Key result
The Kearon score was the most accurate of four evaluated scores for predicting major bleeding in acute pulmonary embolism patients on anticoagulation (AUC 0.75; 95% CI 0.60-0.89).
Why the study?
Major bleeding and clinically relevant bleeding are frequent complications of anticoagulation for pulmonary embolism, and a bleeding risk score may help accurately assess risk and guide clinical decisions.
Which bleeding risk score best predicts major bleeding and clinically relevant bleeding in patients with acute pulmonary embolism receiving anticoagulation?
Observational (n=563)
No
Which bleeding risk score best predicts major bleeding and clinically relevant bleeding in patients with acute pulmonary embolism receiving anticoagulation?
Effect estimate: AUC 0.75 (95% CI 0.60-0.89)
Among four bleeding risk scores evaluated in patients with acute pulmonary embolism on anticoagulation, only the Kearon score demonstrated acceptable accuracy for predicting major bleeding.
Kearon score may inform major bleeding risk in anticoagulated acute PE; leaves open need for validation and better tools.
BACKGROUND: Major bleeding (MB) and clinically relevant bleeding (CRB) are the most common seen complications associated with anticoagulation treatment for pulmonary embolism (PE) patients. A bleeding risk score (BRS) may help to accurately determine the risk of bleeding and make better decisions for patients in clinical practice. METHODS: Patients diagnosed as acute PE and who met the inclusion criteria in Beijing Chao-Yang Hospital from January 2009 to September 2013 were consecutively enrolled. Baseline data were collected. Four BRS (Kuijer score, RIETE score, Kearon score and Nieuwenhuis score) were assessed and compared using the area under the receiver operating characteristic curve (AUC). RESULTS: A total number of 563 patients were included in the study. Of which, 16 had MB and 89 had CRB within three months of anticoagulation treatment. Three months' cumulative incidence for MB and CRB events was 0.03 (95% CI 0.01-0.05) and 0.17 (95% CI 0.12-0.21), respectively. In our study population, the AUCs for Kuijer, RIETE, Kearon and Nieuwenhuis scores were 0.57 (95% CI 0.44~0.68), 0.56 (95% CI 0.45-0.71), 0.75 (95% CI 0.60~0.89) and 0.59 (95% CI 0.41~0.74), respectively. In addition, the AUCs of four BRS for CRB were all poor, with values less than 0.65. CONCLUSIONS: Only the Kearon score appeared to have more accuracy in predicting the risk of MB. Further large prospective studies are needed to externally validate a BRS for CRB.
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Zhang et al. (2019) conducted an observational in Pulmonary embolism (n=563). Bleeding risk scores (Kuijer, RIETE, Kearon, Nieuwenhuis) was evaluated on Prediction of major bleeding (AUC) (AUC 0.75, 95% CI 0.60-0.89). The Kearon score was the most accurate of four evaluated scores for predicting major bleeding in acute pulmonary embolism patients on anticoagulation (AUC 0.75; 95% CI 0.60-0.89).
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