Key result
RIETE score predicts 90-day major bleeding in PE patients with a modest 0.70 AUC.
Why the study?
Most bleeding risk scores for PE were developed with traditional anticoagulants, leaving limited evidence regarding their applicability to DOACs and East Asian populations.
Does initial DOAC treatment reduce composite outcomes compared to LMWH in low bleeding risk patients with pulmonary embolism?
Cohort (n=7,619)
Yes
Does initial DOAC treatment reduce composite outcomes compared to LMWH in low bleeding risk patients with pulmonary embolism?
Effect estimate: AUC 0.70 (95% CI 0.65-0.75)
The RIETE score provides modest prediction of major bleeding in PE patients and identifies low-risk patients who may benefit from early DOAC therapy over LMWH.
RIETE score offers only modest bleeding prediction in PE and should not yet guide DOAC selection; leaves open prospective validation in low-risk cohorts.
Background: Most bleeding risk scores for pulmonary embolism (PE) were developed in patients receiving traditional anticoagulants. Evidence in East Asian populations and its applicability to direct oral anticoagulants (DOACs) remain limited. Methods: This post-hoc analysis was based on a multicentre, prospective study (NCT02943343) conducted from 2016 to 2021. The predictive performance of bleeding risk scores was assessed using a time-dependent area under the receiver operating characteristic curve (AUC), net reclassification improvement (NRI), and decision curve analysis (DCA). Propensity score matching (PSM) was adjusted for baseline characteristics. We analyzed the impact of initial DOAC versus low-molecular-weight heparin (LMWH) on outcomes. The endpoint was major bleeding (MB) within 90 days and composite outcomes (all-cause mortality, recurrent VTE, and MB). Results: Of 7,619 patients with PE, 1.4% (107 patients) experienced MB within 90 days. The RIETE score showed a modest predictive ability (AUC: 0.70; 95% CI, 0.65-0.75) for predicting 90-day MB and demonstrated a predictive advantage in the DCA results. NRI also revealed significantly better reclassification capability than the other scores, except for HAS-BLED. Among low-risk patients classified by the RIETE score, initial DOAC treatment significantly reduced 14-day composite outcomes compared with LMWH (HR = 0.13; 95% CI, 0.02-0.93). Furthermore, DOACs at discharge did not increase the risk of MB or composite outcomes. Conclusion: RIETE score shows modest performance in predicting MB and identifying low bleeding risk in PE patients, which could potentially guide early DOAC use. Further studies are needed to test its clinical utility, especially in East Asian populations.
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Tao et al. (2025) conducted a cohort in Pulmonary embolism (n=7,619). RIETE score vs. Other bleeding risk scores was evaluated on Major bleeding within 90 days (AUC 0.70, 95% CI 0.65-0.75). The RIETE score demonstrated modest predictive ability for 90-day major bleeding in patients with pulmonary embolism (AUC 0.70; 95% CI 0.65-0.75).
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