title: Bleeding Risk Index in an anticoagulation clinic. Assessment by indication and implications for care.
abstract: BACKGROUND
  The Outpatient Bleeding Risk Index (BRI) prospectively classified patients who were at high, intermediate, or low risk for warfarin-related major bleeding. However, there are only 2 published validation studies of the index and neither included veterans.
  
  
  OBJECTIVE
  To determine the accuracy of the BRI in patients attending a Veterans Affairs (VA) anticoagulation clinic and to specifically evaluate the accuracy of the BRI in patients with atrial fibrillation.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Using the BRI, all patients managed by the Anticoagulation Clinic between January 1, 2001 and December 31, 2002 were classified as high, intermediate, or low risk for major bleeding. Bleeds were identified via quality-assurance reports. Poisson regression was used to determine whether there was an association between the index and the development of bleeding.
  
  
  RESULTS
  The rate of major bleeding was 10.6%, 2.5%, and 0.8% per patient-year of warfarin in the high-, intermediate-, and low-risk groups, respectively. Patients in the high-risk category had 14 times the rate of major bleeding of those in the low-risk group (incidence rate ratio (IRR) 14; 95% confidence interval (CI), 1.9 to 104.7). The rate of major bleeding was significantly different between the high- and intermediate-risk categories (P<.001). Among those with atrial fibrillation, patients in the high-risk category had 6 times the major bleeding rate of those in the intermediate- and low-risk groups combined (IRR=6; 95% CI, 2.4 to 15.3).
  
  
  CONCLUSIONS
  The BRI discriminates between high- and intermediate-risk patients in a VA anticoagulation clinic, including those with atrial fibrillation.
authors.affiliation: Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA 15240, USA. sherrie.aspinall@med.va.gov
authors.forename: Sherrie L
authors.initials: SL
authors.lastname: Aspinall
authors.forename: Beth E
authors.initials: BE
authors.lastname: DeSanzo
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Trilli
authors.forename: Chester B
authors.initials: CB
authors.lastname: Good
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects*; D001281:Atrial Fibrillation / Q000188:drug therapy; D015331:Cohort Studies; D003661:Decision Support Techniques; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D008297:Male; D016012:Poisson Distribution; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014859:Warfarin / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants; D014859:Warfarin