Prediction and prognostic importance of in-hospital major bleeding in a real-world cohort of patients with pulmonary embolism

Abstract

Background: Assessment of bleeding risk in patients with pulmonary embolism (PE) is challenging. Recently, the VTE-BLEED score was shown to predict major bleeding. Therefore, we aimed to investigate the VTE-BLEED score and assess the prognostic impact of major bleeding in a real-world cohort of PE patients. Methods: Consecutive PE patients included in a prospective single-center cohort study between 09/2008 and 11/2016 were eligible for analysis; patients treated with thrombolysis were excluded. The VTE-BLEED was calculated post-hoc; in-hospital major bleeding was defined using the ISTH definition. Results: Overall, 522 patients (median age 69, IQR 56-78 years; 53% female) were included in the present analysis; major bleeding occurred in 18 (3.5%) patients. A VTE-BLEED score ≥2 points identified patients at high-risk for major bleeding (OR 3.7, 95% CI 1.1-13.0, sensitivity 83%, specificity 42%). Additionally, a GFR b30 ml/min/1.73 m 2 (OR 6.0, 95% CI 1.8-19.8) and previous surgery (OR 3.6, 95% CI 1.4-9.3) were associated with major bleeding. A less frequent use of unfractionated heparin as initial treatment was associated with a decrease of major bleeding over time. Major bleeding was identified as strong predictor of inhospital (OR 7.7, 95% CI 2.3-25.8) and 1-year mortality (HR 3.6, 95% CI 2.0-6.6), especially in normotensive patients (OR 12.1, 95% CI 3.5-43.0 and HR 6.0, 95% CI 2.9-12.6, respectively). Conclusions: In a real-world cohort, the VTE-BLEED score identified PE patients at risk for in-hospital major bleeding. However, for assessment of bleeding risk, renal function and previous surgery should be considered. Major bleeding emerged as strong predictor of in-hospital and 1-year mortality.

Pulmonary embolism in patients with severe COVID-19 treated with intermediate- to full-dose enoxaparin: A retrospective study

“…The choice to use intermediate-or full-dose enoxaparin was always made in consideration of the patient's risk for bleeding. 15 The clinical characteristics, adverse events probably related to enoxaparin therapy (thrombocytopenia [i.e., platelet level < 50,000/µL], hematomas, bleeding requiring transfusion of two or more units of concentrated red blood cells), and outcomes of these consecutive patients with COVID-19 were retrospectively analyzed. This study was approved by the Valpadana ATS ethics committee (Cremona, Italy) on July 7, 2020.…”

Prediction of bleeding events using the VTE‑BLEED risk score in patients with venous thromboembolism receiving anticoagulant therapy (Review)

“…Both scores were applied on patients from the real-world cohort of PERGO (Pulmonary Embolism Registry of Goettingen). While HAS-BLED risk score ≥2 points was not able to predict major bleeding (OR, 1.1; 95% CI, 0.4-2.9), a VTE-BLEED risk score of ≥2 points was a good predictor of in-hospital major bleeding events with OR 3.7 (95% CI, 1.1-13.0) (20).…”

“…There are many data suggesting that the bleeding risk is not constant throughout the anticoagulant treatment period (16,19). The highest occurrence of major bleeding is at the onset of anticoagulation and may reflect the importance of the patient's underlying diseases (20). Moreover, overlapping two types of anticoagulants in the very early phase of the treatment, either low-molecular-weight heparin (LMWH) or unfractionated heparin (UFH) with a vitamin K antagonist (VKA), raises the bleeding risk.…”

Pulmonary embolism in patients with severe COVID-19 treated with intermediate- to full-dose enoxaparin

“…they were dependent on NIV), the patient was treated with full-dose enoxaparin. The choice to use intermediate-or full-dose enoxaparin was always made with consideration of the patient's bleeding risk [13].…”