A simple risk score may be effective in quantifying the risk for community-acquired vitamin K antagonist (VKA)-associated significant bleeding events in patients with venous thromboembolism (VTE), according to findings published in the British Journal of Haematology. The risk score was found to be particularly effective in identifying patients considered to be at high risk for major bleeding.

A team of investigators developed the risk stratification score to predict VKA-associated bleeding in patients with VTE by examining data from the United Kingdom Clinical Practice Research Datalink. They analyzed community-acquired bleeding outcomes in an outpatient cohort of 10,010 patients with VTE (mean age, 62.2 years) who experienced first VTE between January 2008 and March 2016. All the patients received VKA treatment within 30 days of the initial VTE.

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A significant bleeding event was defined as a major bleeding event or a clinically relevant nonmajor bleeding requiring hospitalization (CRNMB-H) within 90 days of VKA initiation. Using subhazard ratios, the researchers created a scoring scheme for predicting bleeding and validated it using cross-validation, which was expressed by the C-statistic.

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The researchers found that 167 significant bleeding events, including 44 major bleeding events and 123 CRNMB-H events, were recorded between 2008 and 2016, yielding an incidence rate of 7.4 per 100 person-years. Independent predictors for community-acquired significant bleeding included active cancer, trauma or surgical procedure, male gender, dementia, liver disease, and anemia. Overall, the score had a C-statistic of 0.68 (95% CI, 0.60-0.76); the C-statistics for major bleeding and CRNMB-H were 0.75 (95% CI, 0.60-0.88) and 0.65 (95% CI, 0.55-0.75), respectively.

The researchers wrote that adopting a simple risk score may be effective for better quantifying the risk for VKA-associated community-acquired significant bleeding events and may help guide clinicians. “It may prove useful to prevent major bleeding by facilitating the awareness for the bleeding risk and for considering treatment with anticoagulants other than [VKAs],” concluded the researchers.

Disclosures: Some authors have declared affiliations with the pharmaceutical industry. Please refer to the original study for a full list of disclosures.


  1. Martinez C, Katholing A, Wallenhorst C, Cohen AT. Prediction of significant bleeding during vitamin K antagonist treatment for venous thromboembolism in outpatients [published online January 29, 2020]. Br J Haematol. doi:10.1111/bjh.16383