Factors at admission associated with bleeding risk in medical patients: findings from the IMPROVE investigators.
BACKGROUND
Acutely ill, hospitalized medical patients are at risk of VTE. Despite guidelines for VTE prevention, prophylaxis use in these patients is still poor, possibly because of fear of bleeding risk. We used data from the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) to assess in-hospital bleeding incidence and to identify risk factors at admission associated with in-hospital bleeding risk in acutely ill medical patients.


METHODS
IMPROVE is a multinational, observational study that enrolled 15,156 medical patients. The in-hospital bleeding incidence was estimated by Kaplan-Meier analysis. A multiple regression model analysis was performed to identify risk factors at admission associated with bleeding.


RESULTS
The cumulative incidence of major and nonmajor in-hospital bleeding within 14 days of admission was 3.2%. Active gastroduodenal ulcer (OR, 4.15; 95% CI, 2.21-7.77), prior bleeding (OR, 3.64; 95% CI, 2.21-5.99), and low platelet count (OR, 3.37; 95% CI, 1.84-6.18) were the strongest independent risk factors at admission for bleeding. Other bleeding risk factors were increased age, hepatic or renal failure, ICU stay, central venous catheter, rheumatic disease, cancer, and male sex. Using these bleeding risk factors, a risk score was developed to estimate bleeding risk.


CONCLUSIONS
We assessed the incidence of major and clinically relevant bleeding in a large population of hospitalized medical patients and identified risk factors at admission associated with in-hospital bleeding. This information may assist physicians in deciding whether to use mechanical or pharmacologic VTE prophylaxis.
Decousus
Hervé
H
INSERM, CIE3, the University Saint-Etienne, and CHU Saint-Etienne, Hôpital Nord, Service de Médecine Interne et Thérapeutique, Saint-Etienne, France. herve.decousus@chu-st-etienne.fr
Tapson
Victor F
VF
Bergmann
Jean-François
JF
Chong
Beng H
BH
Froehlich
James B
JB
Kakkar
Ajay K
AK
Merli
Geno J
GJ
Monreal
Manuel
M
Nakamura
Mashio
M
Pavanello
Ricardo
R
Pini
Mario
M
Piovella
Franco
F
Spencer
Frederick A
FA
Spyropoulos
Alex C
AC
Turpie
Alexander G G
AG
Zotz
Rainer B
RB
Fitzgerald
Gordon
G
Anderson
Frederick A
FA
D000208:Acute Disease; D000368:Aged; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007297:Inpatients; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000592:standards*; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013923:Thromboembolism / Q000188:drug therapy
D005343:Fibrinolytic Agents