[Validation of a score for predicting bleeding events during acute coronary syndromes].
BACKGROUND
bleeding is a major complication in patients treated for acute coronary syndromes (ACS) with antithrombotic and invasive therapies. Consequently, the benefit of such therapies should be balanced against the potential risk of hemorrhagic complications. Therefore, a score to estimate individual risk of bleeding might represent an important tool in clinical decision-making.


OBJECTIVE
this study aims to create and validate a bleeding risk score for patients with ACS.


METHODS
independent predictors of bleeding reported by the GRACE Registry were utilized. Variables with odds ratio (OR) > 2.5 in that Registry added 3 points (previous history of bleeding), OR = 1.5-2.4 added 2 points (creatinine clearance < 30 ml/min, female gender) and those with OR < 1.5 added 1 point (clearance between 30 and 60 ml/min, each 10 years of age>30, ST-deviation, peripheral artery disease and smoking). The score was validated in a cohort of 383 individuals with ACS. In-hospital bleeding was defined as hematocrit fall > 10%, blood transfusion > 2 units, intracerebral bleeding or fatal bleeding.


RESULTS
the incidence of bleeding events was 3.1% and the score's C-statistics was 0.66 (95% CI = 0.52-0.80), indicating a predictive ability towards these events. Those with a score > 7 had 6% incidence of bleeding, compared with 1.9% if the score was < 7 (RR = 3.2; 95%CI = 1.04-9.9; p = 0.03). There was an interaction between a score > 7 and greater risk imposed by treatment with Clopidogrel (p = 0.02), IIb/IIIa blockers (p = 0.06) and surgical revascularization (p < 0.001).


CONCLUSIONS
the score discriminates bleeding risk and is potentially useful in clinical decision-making during ACS.
Correia
Luis C L
LC
Hospital Português, Escola Bahiana de Medicina, Salvador, BA, Brasil. lccorreia@terra.com.br
Merelles
Saulo
S
Vasconcelos
Ana
A
Cerqueira
Thais
T
Reis
Tiago
T
Esteves
Carolina
C
Lima
José C
JC
Esteves
J Péricles
JP
D054058:Acute Coronary Syndrome / Q000628:therapy*; D000368:Aged; D016009:Chi-Square Distribution; D003404:Creatinine / Q000097:blood; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects; D006801:Humans; D008297:Male; D019106:Postoperative Hemorrhage / Q000139:chemically induced / Q000175:diagnosis / Q000517:prevention & control*; D011237:Predictive Value of Tests; D018570:Risk Assessment / Q000379:methods / Q000592:standards
D005343:Fibrinolytic Agents; D003404:Creatinine