Risk factors for bleeding during treatment of acute venous thromboembolism.
OBJECTIVE
Identification of risk factors for bleeding and prospective evaluation of two bleeding risk scores in the treatment of acute venous thromboembolism.


METHODS
Secondary analysis of a prospective, randomized, assessorblind, multicenter clinical trial.


METHODS
One university and 2 regional teaching hospitals.


METHODS
188 patients treated with heparin or danaparoid for acute venous thromboembolism.


METHODS
The presenting clinical features, the doses of the drugs, and the anticoagulant responses were analyzed using univariate and multivariate logistic regression analysis in order to evaluate prognostic factors for bleeding. In addition, the recently developed Utrecht bleeding risk score and Landefeld bleeding risk index were evaluated prospectively.


RESULTS
Major bleeding occurred in 4 patients (2.1%) and minor bleeding in 101 patients (53.7%). For all (major and minor combined) bleeding, body surface area < or = 2 m2 (odds ratio 2.3, 95% CI 1.2-4.4; p = 0.01), and malignancy (odds ratio 2.4, 95% CI 1.1-4.9; p = 0.02) were confirmed to be independent risk factors. An increased treatment-related risk of bleeding was observed in patients treated with high doses of heparin, independent of the concomitant activated partial thromboplastin time ratios. Both bleeding risk scores had low diagnostic value for bleeding in this sample of mainly minor bleeders.


CONCLUSIONS
A small body surface area and malignancy were associated with a higher frequency of bleeding. The bleeding risk scores merely offer the clinician a general estimation of the risk of bleeding. In patients with a small body surface area or in patients with malignancy, it may be of interest to study whether limited dose reduction of the anticoagulant drug may cause less bleeding without affecting efficacy.
Wester
J P
JP
Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands.
de Valk
H W
HW
Nieuwenhuis
H K
HK
Brouwer
C B
CB
van der Graaf
Y
Y
Meuwissen
O J
OJ
Hart
H C
HC
Sixma
J J
JJ
Banga
J D
JD
D000074:Acenocoumarol / Q000008:administration & dosage / Q000627:therapeutic use; D000208:Acute Disease; D000328:Adult; D000368:Aged; D001830:Body Surface Area; D002809:Chondroitin Sulfates / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D015897:Comorbidity; D003871:Dermatan Sulfate / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D004338:Drug Combinations; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology*; D006493:Heparin / Q000009:adverse effects* / Q000627:therapeutic use; D006497:Heparan Sulfate / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology; D016017:Odds Ratio; D011446:Prospective Studies; D012307:Risk Factors; D016037:Single-Blind Method; D013923:Thromboembolism / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects*
D000074:Acenocoumarol; D002809:Chondroitin Sulfates; D003871:Dermatan Sulfate; D004338:Drug Combinations; D005343:Fibrinolytic Agents; D006493:Heparin; D006497:Heparan Sulfate; C035838:danaparoid