Validation of the International Medical Prevention Registry on Venous Thromboembolism Bleeding Risk Score

Hostler, David C.; E, Marx; Moores, Lisa K.; Petteys, Sarah; Hostler, Jordanna; Mitchell, Joshua D.; Holley, Paul R.; Collen, Jacob; Foster, Brian; Holley, Aaron B.

doi:10.1378/chest.14-2842

Cited by 70 publications

(74 citation statements)

References 25 publications

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“…The point-estimate of the low-risk-of-bias trials suggested a 70% RRI in major bleeding which was not statistically significant, while the estimate including all trials was neutral. This difference may relate to bias risk but could also be explained by trial characteristics: cancer and treatment duration are risk factors for major bleeding, and three out of five low-risk-of-bias trials included oncological patients who were generally treated for a longer duration [26]. The increased risk of major bleeding in the subgroup of oncological patients was comparable to that reported in previous systematic reviews for this patient category [6,7].…”

Section: Considerations On the Optimal Prophylactic Dosementioning

confidence: 51%

Low Dose Low-Molecular-Weight Heparin for Thrombosis Prophylaxis: Systematic Review with Meta-Analysis and Trial Sequential Analysis

Eck

Bult

Wetterslev

et al. 2019

JCM

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International guidelines recommend low-molecular-weight heparin (LMWH) as first-line pharmacological option for the prevention of venous thromboembolism (VTE) in many patient categories. Guidance on the optimal prophylactic dose is lacking. We conducted a systematic review with meta-analysis and trial sequential analysis (TSA) of randomized controlled trials to assess benefits and harms of low-dose LMWH versus placebo or no treatment for thrombosis prophylaxis in patients at risk of VTE. PubMed, Cochrane Library, Web of Science, and Embase were searched up to June 2019. Results were presented as relative risk (RR) with conventional and TSA-adjusted confidence intervals (CI). Forty-four trials with a total of 22,579 participants were included. Six (14%) had overall low risk of bias. Low-dose LMWH was not statistically significantly associated with all-cause mortality (RR 0.99; 95%CI 0.85-1.14; TSA-adjusted CI 0.89-1.16) but did reduce symptomatic VTE (RR 0.62; 95%CI 0.48-0.81; TSA-adjusted CI 0.44-0.89) and any VTE (RR 0.61; 95%CI 0.50-0.75; TSA-adjusted CI 0.49-0.82). Analyses on major bleeding (RR 1.07; 95%CI 0.72-1.59), as well as serious adverse events (SAE) and clinically relevant non-major bleeding were inconclusive. There was very low to moderate-quality evidence that low-dose LMWH for thrombosis prophylaxis did not decrease all-cause mortality but reduced the incidence of symptomatic and asymptomatic VTE, while the analysis of the effects on bleeding and adverse events remained inconclusive.

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Section: Considerations On the Optimal Prophylactic Dosementioning

confidence: 51%

Low Dose Low-Molecular-Weight Heparin for Thrombosis Prophylaxis: Systematic Review with Meta-Analysis and Trial Sequential Analysis

Eck

Bult

Wetterslev

et al. 2019

JCM

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“…Many bleeding-risk prediction scores have been reported previously; however, most of them were derived and validated in Western AF or VTE patients. 1,[3][4][5][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] To our knowledge, this study was the first to validate the four BRS in Chinese PE patients who received anticoagulant therapy. Several previous studies have been conducted to externally validate and compare the prediction values of these BRS in Western VTE patients; however, the conclusions were inconsistent.…”

Section: Discussionmentioning

confidence: 94%

“…Identifying the factors that are significantly associated with bleeding may help predict patient prognosis and improve patient management in clinical practice. Many bleeding‐risk prediction scores have been reported previously; however, most of them were derived and validated in Western AF or VTE patients …”

Section: Discussionmentioning

confidence: 99%

Comparison of prediction value of four bleeding risk scores for pulmonary embolism with anticoagulation: A real‐world study in Chinese patients

Zhu

Lei

Zhai

et al. 2019

Clinical Respiratory J

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Background Major bleeding (MB) and clinically relevant bleeding (CRB) are the most common seen complications associated with anticoagulation treatment for pulmonary embolism (PE) patients. A bleeding risk score (BRS) may help to accurately determine the risk of bleeding and make better decisions for patients in clinical practice. Methods Patients diagnosed as acute PE and who met the inclusion criteria in Beijing Chao‐Yang Hospital from January 2009 to September 2013 were consecutively enrolled. Baseline data were collected. Four BRS (Kuijer score, RIETE score, Kearon score and Nieuwenhuis score) were assessed and compared using the area under the receiver operating characteristic curve (AUC). Results A total number of 563 patients were included in the study. Of which, 16 had MB and 89 had CRB within three months of anticoagulation treatment. Three months' cumulative incidence for MB and CRB events was 0.03 (95% CI 0.01‐0.05) and 0.17 (95% CI 0.12‐0.21), respectively. In our study population, the AUCs for Kuijer, RIETE, Kearon and Nieuwenhuis scores were 0.57 (95% CI 0.44~0.68), 0.56 (95% CI 0.45‐0.71), 0.75 (95% CI 0.60~0.89) and 0.59 (95% CI 0.41~0.74), respectively. In addition, the AUCs of four BRS for CRB were all poor, with values less than 0.65. Conclusions Only the Kearon score appeared to have more accuracy in predicting the risk of MB. Further large prospective studies are needed to externally validate a BRS for CRB.

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“…Otra escala es IMPROVE VTE Risk Factor, la cual indica que hay un alto riesgo de VTE cuando se tiene un puntaje de dos puntos [15] . Además, fue necesaria la introducción de otras escalas -como la IMPROVE Bleeding Score (Tabla 2)-para disminuir los episodios de sangrado secundario a la tromboprofilaxis farmacológica [17,18] .…”

Section: Introductionunclassified

Experiencia en el uso de tromboprofilaxis farmacológica en un hospital colombiano de tercer nivel

et al. 2018

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Objetivo: Describir las características de la población con patologías no quirúrgicas en quien se indicó manejo de tromboprofilaxis farmacológica en un hospital de tercer nivel y determinar la indicación según riesgo de tromboembolia venosa (VTE) y sangrado con las escalas Padua e IMPROVE Bleeding Score. Materiales y métodos: estudio observacional, descriptivo, de corte transversal que incluyó a pacientes > 18 años, con patología no quirúrgica del servicio de medicina interna, con estancia hospitalaria mínima de 48 horas, atendidos entre el 1 de junio de 2015 a 1 de junio de 2016. En la valoración de riesgo de VTE y sangrado se aplicaron las escalas Padua e IMPROVE Bleeding Score, respectivamente. Resultados: se incluyeron 531 pacientes, de los que el 51,78% fueron hombres, con una edad promedio de 66 años y hospitalización de 37,2 días. La indicación farmacológica más empleada fue la heparina de bajo peso molecular (76,3%). De acuerdo a la escala de Padua, solo 225 pacientes (42,37%) tenían un alto riesgo de tener VTE; según la IMPROVE Bleeding Score, 447 (84,18%) pacientes presentaban bajo riesgo de sangrado y 84 pacientes (15,81%) alto riesgo. Además, se observó que los pacientes con puntaje PADUA ≥ 4, el 21,33% tenía puntaje IMPROVE Bleeding Score ≥7, adicionalmente el 20,23% de los pacientes con alto riesgo de sangrado según esta última escala presentó un episodio de sangrado. Conclusión: se evidenció un sobreuso de tromboprofilaxis farmacológica, lo cual se ve reflejado en episodios de sangrado en paciente que no tenían indicado su uso.

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Validation of the International Medical Prevention Registry on Venous Thromboembolism Bleeding Risk Score

Abstract: The IMPROVE BRS calculated at admission predicts major bleeding in medical inpatients. This model may help assess the relative risks of bleeding and VTE before chemoprophylaxis is administered.

Cited by 70 publications

References 25 publications

Low Dose Low-Molecular-Weight Heparin for Thrombosis Prophylaxis: Systematic Review with Meta-Analysis and Trial Sequential Analysis

Low Dose Low-Molecular-Weight Heparin for Thrombosis Prophylaxis: Systematic Review with Meta-Analysis and Trial Sequential Analysis

Comparison of prediction value of four bleeding risk scores for pulmonary embolism with anticoagulation: A real‐world study in Chinese patients

Experiencia en el uso de tromboprofilaxis farmacológica en un hospital colombiano de tercer nivel

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