Six available bleeding scoring systems poorly predicted early major bleeding in patients with acute pulmonary embolism, yielding Harrel's C-indices ranging from 0.57 to 0.69.
Cohort (n=2,754)
Yes
Do available bleeding scoring systems accurately predict early major bleeding in patients with acute pulmonary embolism?
Currently available bleeding risk scores have poor predictive accuracy for early major bleeding in acute pulmonary embolism, highlighting the need for PE-specific risk scores.
Effect estimate: Harrel's C-index 0.57 to 0.69
We aimed to compare six available bleeding scores, in a real-life cohort, for prediction of major bleeding in the early phase of pulmonary embolism (PE). We recorded in-hospital characteristics of 2754 PE patients in a prospective observational multicenter cohort contributing 18,028 person-days follow-up. The VTE-BLEED (Venous Thrombo-Embolism Bleed), RIETE (Registro informatizado de la enfermedad tromboembólica en España; Computerized Registry of Patients with Venous Thromboembolism), ORBIT (Outcomes Registry for Better Informed Treatment), HEMORR2HAGES (Hepatic or Renal Disease, Ethanol Abuse, Malignancy, Older Age, Reduced Platelet Count or Function, Re-Bleeding, Hypertension, Anemia, Genetic Factors, Excessive Fall Risk and Stroke), ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation), and HAS-BLED (Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile International Normalized Ratio, Elderly, Drugs/Alcohol) scores were assessed at baseline. International Society on Thrombosis and Haemostasis (ISTH)-defined bleeding events were independently adjudicated. Accuracy of the overall original 3-level and newly defined optimal 2-level outcome of the scores were evaluated and compared. We observed 82 first early major bleedings (3.0% (95% CI, 2.4–3.7)). The predictive power of bleeding scores was poor (Harrel’s C-index from 0.57 to 0.69). The RIETE score had numerically higher model fit and discrimination capacity but without reaching statistical significance versus the ORBIT, HEMORR2HAGES, and ATRIA scores. The VTE-BLEED and HAS-BLED scores had significantly lower C-index, integrated discrimination improvement, and net reclassification improvement compared to the others. The rate of observed early major bleeding in score-defined low-risk patients was high, between 15% and 34%. Current available scoring systems have insufficient accuracy to predict early major bleeding in patients with acute PE. The development of acute-PE-specific risk scores is needed to optimally target bleeding prevention strategies.
Mathonier et al. (Mon,) conducted a cohort in Pulmonary embolism (n=2,754). Bleeding scoring systems (VTE-BLEED, RIETE, ORBIT, HEMORR2HAGES, ATRIA, HAS-BLED) was evaluated on First early major bleeding (ISTH-defined) (Harrel's C-index 0.57 to 0.69). Six available bleeding scoring systems poorly predicted early major bleeding in patients with acute pulmonary embolism, yielding Harrel's C-indices ranging from 0.57 to 0.69.