title: Bleeding and venous thromboembolism arising in acutely ill hospitalized medical patients. Findings from the Spanish national discharge database.
abstract: BACKGROUND
  There is scarce evidence to identify which acutely ill medical patients might benefit from prophylaxis against venous thromboembolism (VTE).
  
  
  METHODS
  The Spanish National Discharge Database was used to identify predictors of bleeding and VTE during hospitalization for an acute medical illness.
  
  
  RESULTS
  Of 1,148,301 patients, 3.10% bled, 1.21% were diagnosed with VTE, and 8.64% died. The case-fatality rate was: 20.8% for bleeding and 19.7% for VTE. Eight clinical variables were independently associated with an increased risk for VTE and bleeding, one with a decreased risk for both events, 4 with an increased risk for VTE and a decreased risk for bleeding, 2 with an increased risk for bleeding but a decreased risk for VTE, and 1 with a decreased risk for bleeding. When all these variables were considered, we composed a risk scoring system, in which we assigned points to each variable according to the ratio between the odds ratio for bleeding and for VTE. Overall, 21% of patients scored less than 0 points and had a bleeding vs. VTE ratio of 1.19; 55% scored 0 to 1.0 points and had a ratio of 2.13; and 24% scored over 1.0 points and had a ratio of 6.10.
  
  
  CONCLUSIONS
  A risk score based on variables documented at admission can identify patients with different ratios (near 1.0; about 2.0; and >6.0) between the rate of bleeding and of VTE.
authors.affiliation: Department of Internal Medicine, Hospital Carlos Haya, Málaga, Spain.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Guijarro
authors.affiliation: Department of Internal Medicine, Hospital de la Axarquía, Vélez-Málaga, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: San Roman
authors.affiliation: Department of Surgery, Universidad de Granada and Hospital Virgen de las Nieves, Granada, Spain.
authors.forename: Juan Ignacio
authors.initials: JI
authors.lastname: Arcelus
authors.affiliation: Department of Internal Medicine, Complejo Hospitalario Universitario de Vigo, Spain.
authors.forename: Julio
authors.initials: J
authors.lastname: Montes-Santiago
authors.affiliation: Department of Internal Medicine, Hospital Carlos Haya, Málaga, Spain.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Gómez-Huelgas
authors.affiliation: Department of Internal Medicine, Hospital Carlos Haya, Málaga, Spain.
authors.forename: Patricia
authors.initials: P
authors.lastname: Gallardo
authors.affiliation: Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Spain. Electronic address: mmonreal.germanstrias@gencat.cat.
authors.forename: Manuel
authors.initials: M
authors.lastname: Monreal
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D018890:Chemoprevention; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D000077425:Fondaparinux; D006333:Heart Failure / Q000453:epidemiology*; D006470:Hemorrhage / Q000453:epidemiology*; D006493:Heparin / Q000627:therapeutic use; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011134:Polysaccharides / Q000627:therapeutic use; D011655:Pulmonary Embolism / Q000453:epidemiology* / Q000517:prevention & control; D012131:Respiratory Insufficiency / Q000453:epidemiology*; D018570:Risk Assessment; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D054556:Venous Thromboembolism / Q000453:epidemiology* / Q000517:prevention & control; D020246:Venous Thrombosis / Q000453:epidemiology* / Q000517:prevention & control
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D011134:Polysaccharides; D006493:Heparin; D000077425:Fondaparinux
keywords: Bleeding; Medical patients; Scoring; Venous thromboembolism