VTE-BLEED Risk Score Reliably Identifies Patients With PE at Risk for Major Bleeding

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.”

References

1. 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
2. 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.
3. 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.

This article originally appeared on The Cardiology Advisor