Fatal bleeding in patients receiving anticoagulant therapy for venous thromboembolism: findings from the RIETE registry
J A Nieto, R Solano, M D Ruiz-Ribó, N Ruiz-Gimenez, P Prandoni, C Kearon, M Monreal, Riete Investigators, J I Arcelus, R Barba, A Blanco, M Barrón, T Bueso, I Casado, E Cisneros, R del Campo, F del Molino, J del Toro, C Delgado, M Durán, C Falgá, C Fernández-Capitán, F Gabriel, P Gallego, F García-Bragado, S Gomez-Zorilla, S Guijarro, M Guil, M Gutiérrez J, M R Gutiérrez Tous, L Hernández, D Hernández-Huerta, P Jiménez, S Jordán, R Lecumberri, J L Lobo, L López, A Lorenzo, M Llado, A Maestre, P J Marchena, J J Martín-Villasclaras, M Monreal, M D Nauffal, J A Nieto, M J Núñez, J L Ogea, M Oribe, J M Pedrajas, R Rabuñal, A Riera-Mestre, P Román, V Rosa, A Ruíz-Gamietea, N Ruíz-Giménez, J C Sahuquillo, J F Sánchez Muñoz-Torrero, R Sánchez, S Soler, C Soler, G Tiberio, R Tirado, J A Todolí, C Tolosa, J Trujillo, M Valdés, V Valdés, R Valle, M Vahi, J Vela, J Villalta, H Boccalon, D Farge-Bancel, P Le Corvoisier, K Rivron-Guillot, B Brenner, G Barillari, A Barillari, M Ciammaichella, F Dalla Valle, P Di Micco, R Duce, A Ferrari, S Pasca, R Poggio, P Prandoni, R Quintavalla, L Rota, A Schenone, E Tiraferri, A Visonà, J A Nieto, R Solano, M D Ruiz-Ribó, N Ruiz-Gimenez, P Prandoni, C Kearon, M Monreal, Riete Investigators, J I Arcelus, R Barba, A Blanco, M Barrón, T Bueso, I Casado, E Cisneros, R del Campo, F del Molino, J del Toro, C Delgado, M Durán, C Falgá, C Fernández-Capitán, F Gabriel, P Gallego, F García-Bragado, S Gomez-Zorilla, S Guijarro, M Guil, M Gutiérrez J, M R Gutiérrez Tous, L Hernández, D Hernández-Huerta, P Jiménez, S Jordán, R Lecumberri, J L Lobo, L López, A Lorenzo, M Llado, A Maestre, P J Marchena, J J Martín-Villasclaras, M Monreal, M D Nauffal, J A Nieto, M J Núñez, J L Ogea, M Oribe, J M Pedrajas, R Rabuñal, A Riera-Mestre, P Román, V Rosa, A Ruíz-Gamietea, N Ruíz-Giménez, J C Sahuquillo, J F Sánchez Muñoz-Torrero, R Sánchez, S Soler, C Soler, G Tiberio, R Tirado, J A Todolí, C Tolosa, J Trujillo, M Valdés, V Valdés, R Valle, M Vahi, J Vela, J Villalta, H Boccalon, D Farge-Bancel, P Le Corvoisier, K Rivron-Guillot, B Brenner, G Barillari, A Barillari, M Ciammaichella, F Dalla Valle, P Di Micco, R Duce, A Ferrari, S Pasca, R Poggio, P Prandoni, R Quintavalla, L Rota, A Schenone, E Tiraferri, A Visonà
Abstract
Background: Fatal bleeding is a serious consequence of anticoagulant therapy, but factors associated with fatal bleeding during the first 3 months of treatment of venous thromboembolism (VTE) are uncertain.
Methods: Using data from RIETE, an ongoing registry of consecutive patients with acute VTE, we assessed risk factors for fatal bleeding among all patients. We then used this information to derive a clinical model that would stratify a patient's risk of fatal bleeding during the first 3 months of treatment.
Results: Of 24 395 patients, 546 (2.24%) had a major bleed and 135 (0.55%) had a fatal bleed. The gastrointestinal tract was the most common site (40% of fatal bleeds), followed by intracranial bleeding (25%). Fatal bleeding was independently associated with the following factors at the time of VTE diagnosis: age >75 years (OR, 2.16), metastatic cancer (OR, 3.80), immobility > or = 4 days (OR, 1.99), a major bleed within the past 30 days (OR, 2.64), an abnormal prothrombin time (OR, 2.09), a platelet count < 100 x 10(9) L(-1) (OR, 2.23), creatinine clearance < 30 mL min(-1) (OR, 2.27), anemia (OR, 1.54), and distal deep vein thrombosis (OR, 0.39). INR at the time of bleeding is not known. A clinical prediction rule for risk of fatal bleeding that included nine baseline factors was derived. Fatal bleeding occurred in 0.16% (95% CI, 0.11-0.23) of the low-risk, 1.06% (95% CI, 0.85-1.30) of the moderate-risk, and 4.24% (95% CI, 2.76-6.27) of the high-risk category.
Conclusions: Patient characteristics and laboratory variables can identify patients at high risk for fatal bleeding during treatment of VTE.
References
429 Too Many Requests
Your access to the NCBI website at pubmed.ncbi.nlm.nih.gov has been temporarily blocked due to possible misuse.
This is not an indication of a security issue such as a virus or attack.
If you are executing automated queries or otherwise scripting against the PubMed website, please review how to use E-utilities,
The Entrez Programming Utilities (E-utilities) are a set of nine server-side programs that provide a stable interface into the Entrez query and database system at the National Center for Biotechnology Information (NCBI)
If you have further questions, please contact info@ncbi.nlm.nih.gov.
Source: PubMed