The recently proposed VTE-BLEED score may be useful for identifying patients with pulmonary embolism (PE) who are at risk for in-hospital major bleeding, according to a prospective, single-center cohort study published in the International Journal of Cardiology.1
The VTE-BLEED score identifies 6 differently weighted variables (active cancer [2 points], men with uncontrolled hypertension [1 point], anemia [1.5 points], history of bleeding [1.5 points], age ³60 years [1.5 points], and renal dysfunction [1.5 points]) as predictors of major bleeding in patients with venous thromboembolism (VTE) receiving either warfarin or dabigatran.2
Although the VTE-BLEED score has been externally validated in previous studies,2,3 validation of the VTE-BLEED score in a real-world cohort of patients with PE has not been performed to date. Therefore, researchers evaluated 522 consecutive patients ≥18 years with confirmed acute PE who were included in the Pulmonary Embolism Registry Göttingen at the University Medical Centre Göttingen, Germany, from September 2008 to November 2016.1
The researchers found that major bleeding occurred in 18 (3.5%) of these patients, and that a VTE-BLEED score of 2 or more points identified patients at high risk for major bleeding. In addition, a glomerular filtration rate of less than 30 mL/min/1.73 m2 and previous surgery were associated with major bleeding.
Major bleeding was identified as a strong predictor of in-hospital and 1-year mortality, especially in normotensive patients.
“In conclusion, in the present real-world cohort of patients with acute PE, the VTE-BLEED score was able to identify patients at risk for in-hospital major bleeding,” stated the authors.1 Thus, reliable bleeding risk assessment tools, such as the VTE-BLEED score, are needed “to predict in-hospital major bleeding and allow for an improved clinical awareness and risk-adapted anticoagulation management.”
- Kresoja KP, Ebner M, Rogge NIJ, et al. Prediction and prognostic importance of in-hospital major bleeding in a real-world cohort of patients with pulmonary embolism [published online March 15, 2019]. Int J Cardiol. doi:10.1016/j.ijcard.2019.03.017
- Klok FA, Hösel V, Clemens A, et al. Prediction of bleeding events in patients with venous thromboembolism on stable anticoagulation treatment. Eur Respir J. 2016;48:1369-1376.
- Klok FA, Barco S, Konstantinides SV. External validation of the VTE-BLEED score for predicting major bleeding in stable anticoagulated patients with venous thromboembolism. Thromb. Haemost. 2017;117:1164-1170.