title: Prospective, multicenter validation of prediction scores for major bleeding in elderly patients with venous thromboembolism.
abstract: BACKGROUND
  The Outpatient Bleeding Risk Index (OBRI) and the Kuijer, RIETE and Kearon scores are clinical prognostic scores for bleeding in patients receiving oral anticoagulants for venous thromboembolism (VTE). We prospectively compared the performance of these scores in elderly patients with VTE.
  
  
  METHODS
  In a prospective multicenter Swiss cohort study, we studied 663 patients aged ≥ 65 years with acute VTE. The outcome was a first major bleeding at 90 days. We classified patients into three categories of bleeding risk (low, intermediate and high) according to each score and dichotomized patients as high vs. low or intermediate risk. We calculated the area under the receiver-operating characteristic (ROC) curve, positive predictive values and likelihood ratios for each score.
  
  
  RESULTS
  Overall, 28 out of 663 patients (4.2%, 95% confidence interval [CI] 2.8-6.0%) had a first major bleeding within 90 days. According to different scores, the rate of major bleeding varied from 1.9% to 2.1% in low-risk, from 4.2% to 5.0% in intermediate-risk and from 3.1% to 6.6% in high-risk patients. The discriminative power of the scores was poor to moderate, with areas under the ROC curve ranging from 0.49 to 0.60 (P = 0.21). The positive predictive values and positive likelihood ratios were low and varied from 3.1% to 6.6% and from 0.72 to 1.59, respectively.
  
  
  CONCLUSIONS
  In elderly patients with VTE, existing bleeding risk scores do not have sufficient accuracy and power to discriminate between patients with VTE who are at a high risk of short-term major bleeding and those who are not.
authors.affiliation: Department of General Internal Medicine, Bern University Hospital and University of Bern, Bern, Switzerland.
authors.forename: N
authors.initials: N
authors.lastname: Scherz
authors.forename: M
authors.initials: M
authors.lastname: Méan
authors.forename: A
authors.initials: A
authors.lastname: Limacher
authors.forename: M
authors.initials: M
authors.lastname: Righini
authors.forename: K
authors.initials: K
authors.lastname: Jaeger
authors.forename: H-J
authors.initials: HJ
authors.lastname: Beer
authors.forename: B
authors.initials: B
authors.lastname: Frauchiger
authors.forename: J
authors.initials: J
authors.lastname: Osterwalder
authors.forename: N
authors.initials: N
authors.lastname: Kucher
authors.forename: C M
authors.initials: CM
authors.lastname: Matter
authors.forename: M
authors.initials: M
authors.lastname: Banyai
authors.forename: A
authors.initials: A
authors.lastname: Angelillo-Scherrer
authors.forename: B
authors.initials: B
authors.lastname: Lämmle
authors.forename: M
authors.initials: M
authors.lastname: Husmann
authors.forename: M
authors.initials: M
authors.lastname: Egloff
authors.forename: M
authors.initials: M
authors.lastname: Aschwanden
authors.forename: H
authors.initials: H
authors.lastname: Bounameaux
authors.forename: J
authors.initials: J
authors.lastname: Cornuz
authors.forename: N
authors.initials: N
authors.lastname: Rodondi
authors.forename: D
authors.initials: D
authors.lastname: Aujesky
mesh_terms: D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects*; D016009:Chi-Square Distribution; D003661:Decision Support Techniques; D016002:Discriminant Analysis; D016903:Drug Monitoring / Q000379:methods; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced*; D006801:Humans; D019934:International Normalized Ratio; D053208:Kaplan-Meier Estimate; D016013:Likelihood Functions; D016015:Logistic Models; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D013557:Switzerland; D013997:Time Factors; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000188:drug therapy*
chemical_list: D000925:Anticoagulants