Prospective, multicenter validation of prediction scores for major bleeding in elderly patients with venous thromboembolism.

Scherz, N; Méan, M; Limacher, A; Righini, M; Jaeger, K; Beer, H-J; Frauchiger, B; Osterwalder, J; Kucher, N; Matter, C M; Banyai, M; Angelillo-Scherrer, A; Lämmle, B; Husmann, M; Egloff, M; Aschwanden, M; Bounameaux, H; Cornuz, J; Rodondi, N; Aujesky, D

Scherz, N; Méan, M; Limacher, A; Righini, M; Jaeger, K; Beer, H-J; Frauchiger, B; Osterwalder, J; Kucher, N; Matter, C M; Banyai, M; Angelillo-Scherrer, A; Lämmle, B; Husmann, M; Egloff, M; Aschwanden, M; Bounameaux, H; Cornuz, J; Rodondi, N; Aujesky, D.

Afiliación

Scherz N; Department of General Internal Medicine, Bern University Hospital and University of Bern, Bern, Switzerland.

J Thromb Haemost ; 11(3): 435-43, 2013 Mar.

Article en En | MEDLINE | ID: mdl-23279158

RESUMEN

BACKGROUND: The Outpatient Bleeding Risk Index (OBRI) and the Kuijer, RIETE and Kearon scores are clinical prognostic scores for bleeding in patients receiving oral anticoagulants for venous thromboembolism (VTE). We prospectively compared the performance of these scores in elderly patients with VTE. METHODS: In a prospective multicenter Swiss cohort study, we studied 663 patients aged ≥ 65 years with acute VTE. The outcome was a first major bleeding at 90 days. We classified patients into three categories of bleeding risk (low, intermediate and high) according to each score and dichotomized patients as high vs. low or intermediate risk. We calculated the area under the receiver-operating characteristic (ROC) curve, positive predictive values and likelihood ratios for each score. RESULTS: Overall, 28 out of 663 patients (4.2%, 95% confidence interval [CI] 2.8-6.0%) had a first major bleeding within 90 days. According to different scores, the rate of major bleeding varied from 1.9% to 2.1% in low-risk, from 4.2% to 5.0% in intermediate-risk and from 3.1% to 6.6% in high-risk patients. The discriminative power of the scores was poor to moderate, with areas under the ROC curve ranging from 0.49 to 0.60 (P = 0.21). The positive predictive values and positive likelihood ratios were low and varied from 3.1% to 6.6% and from 0.72 to 1.59, respectively. CONCLUSION: In elderly patients with VTE, existing bleeding risk scores do not have sufficient accuracy and power to discriminate between patients with VTE who are at a high risk of short-term major bleeding and those who are not.

Asunto(s)

Anticoagulantes/efectos adversos; Técnicas de Apoyo para la Decisión; Hemorragia/inducido químicamente; Tromboembolia Venosa/tratamiento farmacológico; Enfermedad Aguda; Factores de Edad; Anciano; Anciano de 80 o más Años; Distribución de Chi-Cuadrado; Análisis Discriminante; Monitoreo de Drogas/métodos; Femenino; Humanos; Relación Normalizada Internacional; Estimación de Kaplan-Meier; Funciones de Verosimilitud; Modelos Logísticos; Masculino; Valor Predictivo de las Pruebas; Estudios Prospectivos; Curva ROC; Reproducibilidad de los Resultados; Medición de Riesgo; Factores de Riesgo; Suiza; Factores de Tiempo; Resultado del Tratamiento

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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Técnicas de Apoyo para la Decisión / Tromboembolia Venosa / Hemorragia / Anticoagulantes Tipo de estudio: Clinical_trials / Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Aged80 / Female / Humans / Male País/Región como asunto: Europa Idioma: En Revista: J Thromb Haemost Asunto de la revista: HEMATOLOGIA Año: 2013 Tipo del documento: Article País de afiliación: Suiza Pais de publicación: Reino Unido

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