Risk score to predict serious bleeding in stable outpatients with or at risk of atherothrombosis.
OBJECTIVE
To develop a risk score to quantify bleeding risk in outpatients with or at risk of atherothrombosis.


RESULTS
We studied patients in the REACH Registry, a cohort of 68 236 patients with/at risk of atherothrombosis. The outcome of interest was serious bleeding (non-fatal haemorrhagic stroke or bleeding leading to hospitalization and transfusion) over 2 years. Risk factors for bleeding were assessed using modified regression analysis. Multiple potential scoring systems based on the least complex models were constructed. Competing scores were compared on their discriminative ability via logistic regression. The score was validated externally using the CHARISMA population. From a final cohort of 56 616 patients, 804 (1.42%, 95% confidence interval 1.32-1.52) experienced serious bleeding between baseline and 2 years. A nine-item bleeding risk score (0-23 points) was constructed (age, peripheral arterial disease, congestive heart failure, diabetes, hypertension, smoking, antiplatelets, oral anticoagulants, hypercholesterolaemia). Observed incidence of bleeding at 2 years was: 0.46% (score < or = 6); 0.95% (7-8); 1.25% (9-10); 2.76% (> or = 11). The score's discriminative performance was consistent in CHARISMA and REACH (c-statistics 0.64 and 0.68, respectively); calibration in the CHARISMA population was very good (modified Hosmer-Lemeshow c(2) = 4.74; P = 0.69).


CONCLUSIONS
Bleeding risk increased substantially with a score >10. This score can assist clinicians in predicting the risk of serious bleeding and making decisions on antithrombotic therapy in outpatients.
Ducrocq
Gregory
G
INSERM U-698 'Recherche Clinique en Athérothrombose', Department of Cardiology, Centre Hospitalier Universitaire Bichat-Claude Bernard, 46 rue Henri Huchard, Paris Cedex, France. gregory.ducrocq@bch.aphp.fr
Wallace
Joshua S
JS
Baron
Gabriel
G
Ravaud
Philippe
P
Alberts
Mark J
MJ
Wilson
Peter W F
PW
Ohman
Erik Magnus
EM
Brennan
Danielle M
DM
D'Agostino
Ralph B
RB
Bhatt
Deepak L
DL
Steg
Philippe Gabriel
PG
D000368:Aged; D000553:Ambulatory Care; D050197:Atherosclerosis / Q000209:etiology / Q000517:prevention & control*; D042241:Early Diagnosis; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D006470:Hemorrhage / Q000139:chemically induced / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control*
D005343:Fibrinolytic Agents