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Comparison of four scores to predict major bleeding in patients receiving anticoagulation for venous thromboembolism: findings from the RIETE registry

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Abstract

Stratification of the individual bleeding risk prior to initiation of anticoagulation in patients with acute venous thromboembolism (VTE) has the potential to assist clinicians in making decisions about the proper intensity and duration of antithrombotic therapy. It is unclear which of the validated and internationally accepted scores recommended for the achievement of this important task has the best predictive value. We compared the predictive value of four validated scores (by Landefeld, Beyth, Kuijer and Ruiz-Gimenez, respectively) for the development of major bleeding complications occurring in the first 3 months in patients with acute VTE treated with conventional anticoagulation. Based on the population of RIETE Registry (international registry of patients with acute VTE), we identified those patients presenting all the required prognostic variables, and then calculated the ability of each score for predicting the bleeding risk. Of 40,265 eligible patients, we identified 8,717 meeting the recruitment criteria. Overall, 0.9 % of patients experienced at least one episode of major bleeding within 90 days of the index event. The proportion of patients classified as having a low risk varied between 1.2 and 3.7 %, that of patients having an intermediate risk between 76 and 93 %, and that of patients classified as having a high risk between 6.1 and 18 %. The area under the receiver operating characteristic ranged between 0.55 and 0.60, the positive predictive value between 1.5 and 3.2, and the likelihood ratio between 0.72 and 1.59. In conclusion, all four scores show a very low ability to predict the bleeding risk in patients with acute VTE undergoing conventional anticoagulation.

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Acknowledgments

We express our gratitude to Sanofi Spain for supporting this Registry with an unrestricted educational grant. We also express our gratitude to Bayer Pharma AG for supporting this Registry. Bayer Pharma AG’s support was limited to the part of RIETE outside Spain, which accounts for a 19.8 % of the total patients included in the RIETE Registry. We also thank the RIETE Registry Coordinating Center, S & H Medical Science Service, for their quality control data, logistic and administrative support.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Vascular medicine unit, Department of Medicine, Clinica Medica 2, University of Padua, Via Giustiniani 2, 35128, Padua, Italy

    Chiara Piovella, Fabio Dalla Valle, Raffaele Pesavento & Paolo Prandoni

  2. Department of Internal Medicine, Hospital General Universitario Santa Lucía, Murcia, Spain

    Javier Trujillo-Santos

  3. Department of Internal Medicine, Hospital de Can Misses, Ibiza, Spain

    Leonor López

  4. Department of Haematology, Hospital de Tortosa Verge de la Cinta, Tarragona, Spain

    Llorenç Font

  5. Department of Internal Medicine, Hospital Sierrallana, Cantabria, Spain

    Reina Valle

  6. Department of Pneumonology, Hospital Universitario La Fe, Valencia, Spain

    Dolores Nauffal

  7. Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain

    Manuel Monreal

Authors
  1. Chiara Piovella
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  2. Fabio Dalla Valle
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  3. Javier Trujillo-Santos
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  4. Raffaele Pesavento
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  5. Leonor López
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  6. Llorenç Font
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  7. Reina Valle
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  8. Dolores Nauffal
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  9. Manuel Monreal
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  10. Paolo Prandoni
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Consortia

And the RIETE Investigators

Corresponding author

Correspondence to Paolo Prandoni.

Additional information

A full list of RIETE investigators is given in the appendix.

Appendix

Appendix

Coordinator of the RIETE Registry: Dr. Manuel Monreal (Spain).

RIETE Steering Committee Members: Dr. Hervè Decousus (France).

Dr. Paolo Prandoni (Italy).

Dr. Benjamin Brenner (Israel).

RIETE National Coordinators: Dr. Raquel Barba (Spain).

Dr. Pierpaolo Di Micco (Italy).

Dr. Laurent Bertoletti (France).

Dr. Sebastian Schellong (Germany).

Dr. Manolis Papadakis (Greece).

Dr. Inna Tzoran (Israel).

Dr. Abilio Reis (Portugal).

Dr. Marijan Bosevski (R. Macedonia).

Dr. Henri Bounameaux (Switzerland).

Dr. Radovan Malý (Czech Republic).

RIETE Registry Coordinating Center: S and H Medical Science Service.

Members of the RIETE Group:

Spain: Adarraga MD, Arcelus JI, Ballaz A, Barba R, Barrón M, Barrón-Andrés B, Bascuñana J, Blanco-Molina A, Bueso T, Casado I, Castejón N, Conget F, del Molino F, del Toro J, Falgá C, Fernández-Capitán C, Font L, Fuentes MI, Gallego P, García-Bragado F, García-Lorenzo MD, Gómez V, González J, González-Bachs E, Grau E, Guil M, Gutiérrez J, Hernández L, Hernández-Huerta S, Jaras MJ, Jiménez D, Lecumberri R, Lobo JL, López-Jiménez L, López-Montes L, López-Reyes R, López-Sáez JB, Lorente MA, Lorenzo A, Luque JM, Madridano O, Marchena PJ, Martín M, Monreal M, Nauffal D, Nieto JA, Núñez MJ, Ogea JL, Pedrajas JM, Peris ML, Porras JA, Riera-Mestre A, Rivas A, Rodríguez-Dávila MA, Román P, Roncero A, Rosa V, Ruiz-Giménez N, Ruiz J, Sahuquillo JC, Samperiz A, Sánchez Muñoz-Torrero JF, Soler S, Suriñach JM, Tiberio G, Tolosa C, Trujillo-Santos J, Uresandi F, Valdés M, Valero B, Valle R, Vela J, Vidal G, Villalta J, Belgium: Verhamme P, Peerlinck K, Brazil: Gadelha T, Ribeiro R, Vassalo J, Canada: Wells P, CZECH REPUBLIC: Malý R, Hirmerova J, Kaletova M, Tomko T, France: Bertoletti L, Bura-Riviere A, Farge-Bancel D, Hij A, Mahe I, Merah A, Germany: Schellong S, Greece: Babalis D, Papadakis M, Tzinieris I, ISRAEL: Braester A, Brenner B, Tzoran I, Zeltser D, Italy: Amitrano M, Barillari G, Ciammaichella M, Di Micco P, Duce R, Giorgi-Pierfranceschi M, Maida R, Prandoni P, Quintavalla R, Rocci A, Rota L, Tiraferri E, Tonello D, Tufano A, Visonà A, Zalunardo B, Portugal: Sá Bastos M, Sousa MS, Rei R, Republic of Macedonia: Bosevski M, Kovacevic D, Switzerland: Bounameaux H, Mazzolai L.

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Piovella, C., Dalla Valle, F., Trujillo-Santos, J. et al. Comparison of four scores to predict major bleeding in patients receiving anticoagulation for venous thromboembolism: findings from the RIETE registry. Intern Emerg Med 9, 847–852 (2014). https://doi.org/10.1007/s11739-014-1073-8

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  • DOI: https://doi.org/10.1007/s11739-014-1073-8

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