Predicting the risk for major bleeding in elderly patients with venous thromboembolism using the Charlson index. Findings from the RIETE

Cuervo, Covadonga Gómez; Rivas, Agustina; Visonà, Adriana; Ruíz-Giménez, Nuria; Blanco-Molina, Ángeles; Cañas, I.; Portillo, J.A.; López-Miguel, Patricia; Flores, Katia; Monreal, Manuel; Investigators, Riete

doi:10.1007/s11239-020-02274-6

Cited by 5 publications

(4 citation statements)

References 28 publications

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“…Among the age-specific risk factors, an 8-fold increase in the risk of VTE has been attributed to institutionalization in nursing homes, 7 a 6-fold increase from short-term immobility, 7 a 2-fold increase from frailty, 8 and a 2-fold increase with a Charlson Comorbidity Index of more than 4. 9 Unexpectedly, there were no differences in the proportion of cancer, trauma, and confinement between the 2 groups in our cohort, although one may expect that there should be.…”

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confidence: 59%

Demographics and Clinical Outcomes in Patients Older Than 75 Years Treated for Acute Venous Thromboembolism

Chaudhary

Loganathan

Vlazny

et al. 2021

American Journal of Therapeutics

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confidence: 59%

Demographics and Clinical Outcomes in Patients Older Than 75 Years Treated for Acute Venous Thromboembolism

Chaudhary

Loganathan

Vlazny

et al. 2021

American Journal of Therapeutics

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“…11 , 22 In other studies of older patients with VTE, the incidence rates of MB were substantially lower than in ours (0.8-2.4 vs 8.5 events per 100 patient-years). 23 , 24 , 26 Potential reasons include the enrollment of lower-risk patients, 24 , 26 the use of a more restrictive definition of MB, 23 and the management of anticoagulation by specialized clinics. 26 In our study, anticoagulation was managed by primary care physicians, and the anticoagulation quality was slightly lower than in older patients managed by specialized anticoagulation and thrombosis clinics (time spent in the INR therapeutic range of 62% vs 60% to 74%).…”

Section: Discussionmentioning

confidence: 99%

“… 3 Although our results are consistent with findings that advanced age is associated with a 2-fold higher risk of intracranial bleeding, 8 , 45 the low case-fatality of MB (6%) is more difficult to interpret. Overall, reported case-fatality of MB varies widely in older persons with VTE, ranging from 2% to 55%, 7 , 9 , 23 , 26 , 28 and may be attributable to differing patient selection and the lack of a standardized definition of bleeding-related death. It is possible that our definition of death after an intracranial bleed or bleeding with hemodynamic deterioration was more restrictive than in other studies.…”

Section: Discussionmentioning

confidence: 99%

“… 17 , 18 Although >50% of patients with VTE are aged ≥65 years, the older population is underrepresented in clinical VTE trials, 19 , 20 and little is known about the effect of predisposing factors on the risk and the clinical impact of bleeding in older patients with VTE. Earlier studies about anticoagulation-related bleeding in older patients with VTE were limited by the use of administrative data, 11 , 21 , 22 retrospective design, 21 , 22 focus on subgroups (ie, very old or frail patients), 9 , 21 , 23 , 24 , 25 , 26 , 27 or patients with atrial fibrillation 28 , 29 or who had a short follow-up period. 9 , 27 Moreover, evidence from patients anticoagulated for atrial fibrillation may not be extrapolable to patients with VTE who may have a higher risk of bleeding.…”

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confidence: 99%

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Incidence and clinical impact of bleeding events in older patients with acute venous thromboembolism

et al. 2023

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Elderly patients anticoagulated for venous thromboembolism (VTE) have an increased risk of bleeding compared to younger patients. Little is known about the clinical impact of anticoagulation-related bleeding in this growing patient group. To prospectively assess the incidence, clinical impact, and predictors of bleeding in elderly patients anticoagulated for VTE. We analyzed 981 patients aged ≥65 years with acute VTE in a prospective multicenter cohort. 88% were anticoagulated with vitamin K antagonists. Outcomes were the occurrence of a major (MB) or clinically relevant non-major bleeding (CRNMB) during the initial anticoagulation period up to 36 months. We described the incidence and clinical impact of bleeding and examined the association between risk factors and time to a first bleeding using competing risk regression. 100 MB and 125 CRNMB occurred during follow-up. The incidence of MB and CRNMB was 8.5 (95%CI 7.0-10.4) and 13.4 events (95%CI 11.4-15.7) per 100 patient-years, respectively. In patients with MB, 79% required hospitalization, 18% a surgical intervention, and 19% a permanent discontinuation of anticoagulation. 15% of MB were intracranial and 6% fatal. After adjustment, active cancer (sub-hazard ratio [SHR] 1.81, 95%CI 1.12-2.93) and low physical activity (SHR 1.88, 95%CI 1.19-2.98) were associated with MB, and high risk of falls with CRNMB (SHR 2.04, 95%CI 1.39-3.00). Older patients anticoagulated for VTE had a high incidence of MB and CRNMB, and these bleeding episodes caused a great burden of disease. Physicians should carefully weigh the risks/benefits of extended anticoagulation in the older population with VTE.

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Prediction model for major bleeding in anticoagulated patients with cancer-associated venous thromboembolism using machine learning and natural language processing

Muñoz Martín,

Lecumberri,

Souto

et al. 2024

Clin Transl Oncol

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Purpose We developed a predictive model to assess the risk of major bleeding (MB) within 6 months of primary venous thromboembolism (VTE) in cancer patients receiving anticoagulant treatment. We also sought to describe the prevalence and incidence of VTE in cancer patients, and to describe clinical characteristics at baseline and bleeding events during follow-up in patients receiving anticoagulants. Methods This observational, retrospective, and multicenter study used natural language processing and machine learning (ML), to analyze unstructured clinical data from electronic health records from nine Spanish hospitals between 2014 and 2018. All adult cancer patients with VTE receiving anticoagulants were included. Both clinically- and ML-driven feature selection was performed to identify MB predictors. Logistic regression (LR), decision tree (DT), and random forest (RF) algorithms were used to train predictive models, which were validated in a hold-out dataset and compared to the previously developed CAT-BLEED score. Results Of the 2,893,108 cancer patients screened, in-hospital VTE prevalence was 5.8% and the annual incidence ranged from 2.7 to 3.9%. We identified 21,227 patients with active cancer and VTE receiving anticoagulants (53.9% men, median age of 70 years). MB events after VTE diagnosis occurred in 10.9% of patients within the first six months. MB predictors included: hemoglobin, metastasis, age, platelets, leukocytes, and serum creatinine. The LR, DT, and RF models had AUC-ROC (95% confidence interval) values of 0.60 (0.55, 0.65), 0.60 (0.55, 0.65), and 0.61 (0.56, 0.66), respectively. These models outperformed the CAT-BLEED score with values of 0.53 (0.48, 0.59). Conclusions Our study shows encouraging results in identifying anticoagulated patients with cancer-associated VTE who are at high risk of MB.

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Predicting the risk for major bleeding in elderly patients with venous thromboembolism using the Charlson index. Findings from the RIETE

Cited by 5 publications

References 28 publications

Demographics and Clinical Outcomes in Patients Older Than 75 Years Treated for Acute Venous Thromboembolism

Demographics and Clinical Outcomes in Patients Older Than 75 Years Treated for Acute Venous Thromboembolism

Incidence and clinical impact of bleeding events in older patients with acute venous thromboembolism

Prediction model for major bleeding in anticoagulated patients with cancer-associated venous thromboembolism using machine learning and natural language processing

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