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

Détails

ID Serval
serval:BIB_4178C8EA42ED
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Prospective, multicenter validation of prediction scores for major bleeding in elderly patients with venous thromboembolism.
Périodique
Journal of thrombosis and haemostasis
Auteur(s)
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.
ISSN
1538-7836 (Electronic)
ISSN-L
1538-7836
Statut éditorial
Publié
Date de publication
03/2013
Peer-reviewed
Oui
Volume
11
Numéro
3
Pages
435-443
Langue
anglais
Notes
Publication types: Comparative Study ; Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't ; Validation Studies
Publication Status: ppublish
Résumé
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.
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.
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.
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.
Mots-clé
Acute Disease, Age Factors, Aged, Aged, 80 and over, Anticoagulants/adverse effects, Chi-Square Distribution, Decision Support Techniques, Discriminant Analysis, Drug Monitoring/methods, Female, Hemorrhage/chemically induced, Humans, International Normalized Ratio, Kaplan-Meier Estimate, Likelihood Functions, Logistic Models, Male, Predictive Value of Tests, Prospective Studies, ROC Curve, Reproducibility of Results, Risk Assessment, Risk Factors, Switzerland, Time Factors, Treatment Outcome, Venous Thromboembolism/drug therapy
Pubmed
Web of science
Open Access
Oui
Création de la notice
22/01/2013 16:10
Dernière modification de la notice
22/10/2019 5:11
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