Key result
High IMPROVE Bleeding Risk Score is linked to ~4-fold higher risk of major bleeding.
Why the study?
The IMPROVE Bleeding Risk Score is the only externally validated tool for predicting in-hospital bleeding, but previous studies evaluated patients before initiating VTE prophylaxis rather than among Filipino medical inpatients already receiving prophylaxis.
Does the IMPROVE Bleeding Risk Score (≥7 vs <7) predict in-hospital major and clinically relevant non-major bleeding in adult Filipino medical inpatients receiving pharmacologic VTE prophylaxis?
Cohort (n=152)
No
Does the IMPROVE Bleeding Risk Score (≥7 vs <7) predict in-hospital major and clinically relevant non-major bleeding in adult Filipino medical inpatients receiving pharmacologic VTE prophylaxis?
The IMPROVE Bleeding Risk Score demonstrates good discrimination (AUROC 0.83) and high negative predictive value (92.1%) for predicting in-hospital bleeding among Filipino medical inpatients already receiving pharmacologic VTE prophylaxis.
Supports using the IMPROVE score to rule out bleeding risk during VTE prophylaxis in Filipino inpatients (NPV 92.1%); leaves open larger prospective validation before routine adoption.
Introduction Pharmacologic prophylaxis against venous thromboembolism (VTE) reduces thrombotic events but increases bleeding risk. The International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) Bleeding Risk Score (BRS) is the only externally validated tool for predicting in-hospital bleeding; however, previous studies evaluated patients before initiating prophylaxis. This study aimed to validate the IMPROVE BRS among Filipino medical inpatients who were already receiving prophylaxis, reflecting real-world clinical practice. Purpose This study sought to evaluate the predictive performance of the IMPROVE Bleeding Risk Score in identifying major and clinically relevant non-major bleeding among Filipino medical inpatients receiving pharmacologic VTE prophylaxis. Specifically, it aimed to determine the score’s discrimination, diagnostic accuracy, and clinical utility in a real-world hospital setting. Methods This retrospective cohort included 152 adult medical inpatients at our Hospital who received pharmacologic VTE prophylaxis. Baseline clinical data were used to compute the IMPROVE BRS, classifying patients as low (<7) or high (≥7) risk. Bleeding incidence and predictors were analyzed using logistic regression, relative risk ratios, and receiver operating characteristic (ROC) analysis. Results Bleeding occurred in 15.1% of patients (9.9% major; 5.3% clinically relevant non-major). High-risk patients had a fourfold higher risk of major bleeding (RR 4.0, 95% CI 1.3–12.4). The IMPROVE BRS showed a sensitivity of 73.9%, specificity of 54.3%, PPV of 22.4%, NPV of 92.1%, and AUROC of 0.83, indicating moderate to good discrimination. Conclusion The IMPROVE BRS remains a valid and practical bedside tool even during active pharmacologic prophylaxis, effectively identifying low-risk patients and supporting individualized, safer thromboprophylaxis in Filipino medical inpatients.
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Catangui et al. (2026) conducted a cohort in Acutely ill medical inpatients receiving pharmacologic VTE prophylaxis (n=152). High IMPROVE Bleeding Risk Score (≥7) vs. Low IMPROVE Bleeding Risk Score (<7) was evaluated on Major and clinically relevant non-major in-hospital bleeding (with RR reported for major bleeding) (RR 4.0, 95% CI 1.3-12.4). High IMPROVE Bleeding Risk Score (≥7) predicted a 4-fold higher risk of major bleeding (RR 4.0; 95% CI 1.3-12.4) with an AUROC of 0.83 among inpatients on VTE prophylaxis.
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