Key result
High-risk BLEEPE score linked to ~4.5-fold higher 30-day major bleeding risk in acute PE.
Why the study?
Major bleeding is a feared complication of anticoagulation for acute pulmonary embolism, and existing bleeding risk scores have shown only modest performance in predicting short-term major bleeding.
Does the BLEEPE score accurately stratify the risk of 30-day major bleeding during anticoagulation in patients with acute pulmonary embolism?
Cohort
Yes
Does the BLEEPE score accurately stratify the risk of 30-day major bleeding during anticoagulation in patients with acute pulmonary embolism?
The novel BLEEPE score, utilizing four simple clinical parameters (age >65 years, prior major bleeding, syncope, and hemoglobin <11 g/dl), demonstrates good discrimination and a high negative predictive value (98-99%) for 30-day major bleeding in patients anticoagulated for acute pulmonary embolism.
May support short-term bleeding risk assessment during acute PE anticoagulation; extends prior scores but leaves open prospective outcome trials.
Background Major bleeding (MB) is the most feared complication of anticoagulant treatment in patients with acute pulmonary embolism (PE). Existing bleeding risk scores showed a modest performance, especially for predicting short-term MB. Purpose The aim of this study in patients with acute PE was to develop and validate a risk score for MB at 30-day during anticoagulation: the BLEEPE score. Methods Data from prospective cohorts of patients with acute PE were merged in a collaborative database. Potential predictors (univariate p-value ≤ 0.1) for MB within 30 days were evaluated in a multivariable Cox regression model. Candidate predictors were identified and scored based on clinical relevance and β-coefficient and used to derive the BLEEPE score. The score was internally validated by bootstrap and externally validated in the COPE study population (NCT03631810). The performance of the BLEEPE score was assessed by discrimination (c-statistics), sensitivity, specificity, positive and negative predictive value (NPV). Results Age>65 years, prior MB, syncope, and hemoglobin<11 g/dl were identified as independent predictors of MB in the derivation cohort: incidences of MB in the high and low-risk groups were 7.9% and 1.1%, respectively (HR 7.59, 3.29-17.51) (Table). Incidences in the validation cohort were 6.9% and 1.6%, respectively (HR 4.48, 95% CI 3.39-6.46). C-statistics in derivation and validation cohorts were 0.735 and 0.680, respectively. The NPV was 99% in the derivation and 98% in the validation cohort. Conclusions The BLEEPE score showed a good accuracy and discrimination for 30-day MB in patients with acute PE. The simple parameters included in the BLEEPE score could help to implement strategies for personalized management in this population.
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Vedovati et al. (2026) conducted a cohort in Acute pulmonary embolism. BLEEPE score high-risk group vs. BLEEPE score low-risk group was evaluated on Major bleeding at 30 days (HR 4.48, 95% CI 3.39-6.46). The BLEEPE score stratified 30-day major bleeding risk in acute PE patients, with high vs low-risk validation incidences of 6.9% vs 1.6% (HR 4.48; 95% CI 3.39-6.46).
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