- 1 December 2020
- journal article
- Published by European Respiratory Society (ERS)
Abstract
Background: Improved prediction of the risk of major bleeding in patients with acute pulmonary embolism (PE) receiving systemic thrombolysis is crucial to guide the choice of therapy. Methods: The study included consecutive patients with acute PE who received systemic thrombolysis in the RIETE registry. We used multivariable logistic regression analysis to create a risk score to predict 30-day major bleeding episodes. We externally validated the risk score in patients from the COMMAND VTE registry. In addition, we compared the newly created risk score against the Kuijer and RIETE scores. Results: Multivariable logistic regression identified four predictors for major bleeding: recent major bleeding (3 points), age >75 years (1 point), active cancer (1 point) and syncope (1 point) (BACS). Among 1172 patients receiving thrombolytic therapy in RIETE, 446 (38%) were classified as having low risk (none of the variables present, 0 points) of major bleeding according to the BACS score, and the overall 30-day major bleeding rate of this group was 2.9% (95% CI 1.6-4.9%), compared with 44% (95% CI 14-79%) in the high-risk group (>3 points). In the validation cohort, 51% (149 out of 290) of patients were classified as having low risk, and the overall 30-day major bleeding rate of this group was 1.3%. In RIETE, the 30-day major bleeding event rates in the Kuijer and RIETE low-risk strata were 5.3% and 4.4%, respectively. Conclusions: The BACS score is an easily applicable aid for prediction of the risk of major bleeding in the population of PE patients who receive systemic thrombolysis.Funding Information
- Sanofi España
This publication has 34 references indexed in Scilit:
- Clinical outcomes of patients with pulmonary embolism versus deep vein thrombosis: From the COMMAND VTE RegistryThrombosis Research, 2019
- Trends in mortality related to pulmonary embolism in the European Region, 2000–15: analysis of vital registration data from the WHO Mortality DatabaseThe Lancet Respiratory Medicine, 2019
- A Prospective, Single-Arm, Multicenter Trial of Catheter-Directed Mechanical Thrombectomy for Intermediate-Risk Acute Pulmonary EmbolismКАРДИОЛОГИЯ УЗБЕКИСТАНА, 2019
- Antithrombotic Therapy for VTE DiseaseSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 2016
- Trends in the Management and Outcomes of Acute Pulmonary EmbolismJournal of the American College of Cardiology, 2016
- A Prospective, Single-Arm, Multicenter Trial of Ultrasound-Facilitated, Catheter-Directed, Low-Dose Fibrinolysis for Acute Massive and Submassive Pulmonary EmbolismКАРДИОЛОГИЯ УЗБЕКИСТАНА, 2015
- Thrombolysis for Pulmonary Embolism and Risk of All-Cause Mortality, Major Bleeding, and Intracranial HemorrhageJAMA, 2014
- Survival Effects of Inferior Vena Cava Filter in Patients With Acute Symptomatic Venous Thromboembolism and a Significant Bleeding RiskJournal of the American College of Cardiology, 2014
- Intracerebral Hemorrhage with Thrombolytic Therapy for Acute Pulmonary EmbolismAmerican Journal Of Medicine, 2012
- Overall C as a measure of discrimination in survival analysis: model specific population value and confidence interval estimationStatistics in Medicine, 2004