Karl-Patrik Kresoja1, Matthias Ebner2, Nina I J Rogge3, Carmen Sentler3, Karsten Keller4, Lukas Hobohm5, Gerd Hasenfuß6, Stavros V Konstantinides7, Burkert Pieske1, Mareike Lankeit8. 1. Department of Internal Medicine and Cardiology, Campus Virchow Klinikum (CVK), Charité - University Medicine, Berlin, Germany; Berlin Institute of Health, Berlin, Germany; German Cardiovascular Research Centre (DZHK), partner site Berlin, Germany. 2. Department of Internal Medicine and Cardiology, Campus Virchow Klinikum (CVK), Charité - University Medicine, Berlin, Germany; German Cardiovascular Research Centre (DZHK), partner site Berlin, Germany. 3. Clinic of Cardiology and Pneumology, Heart Center, University Medical Center Goettingen, Germany. 4. Center for Thrombosis and Hemostasis, University Medical Center Mainz, Germany. 5. Center for Thrombosis and Hemostasis, University Medical Center Mainz, Germany; Center for Cardiology, Cardiology I, University Medical Center Mainz, Germany. 6. Clinic of Cardiology and Pneumology, Heart Center, University Medical Center Goettingen, Germany; German Cardiovascular Research Centre (DZHK), partner site Goettingen, Germany. 7. Center for Thrombosis and Hemostasis, University Medical Center Mainz, Germany; Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece. 8. Department of Internal Medicine and Cardiology, Campus Virchow Klinikum (CVK), Charité - University Medicine, Berlin, Germany; German Cardiovascular Research Centre (DZHK), partner site Berlin, Germany; Clinic of Cardiology and Pneumology, Heart Center, University Medical Center Goettingen, Germany; Center for Thrombosis and Hemostasis, University Medical Center Mainz, Germany. Electronic address: mareike.lankeit@charite.de.
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 <30 ml/min/1.73 m2 (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 in-hospital (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.
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 <30 ml/min/1.73 m2 (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 in-hospital (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.
Authors: Paul L den Exter; Scott C Woller; Helia Robert-Ebadi; Camila Masias; Pierre-Emmanuel Morange; David Castelli; John-Bjarne Hansen; Geert-Jan Geersing; Deborah M Siegal; Kerstin de Wit; Frederikus A Klok Journal: J Thromb Haemost Date: 2022-06-23 Impact factor: 16.036