title: Performance of five different bleeding-prediction scores in patients with acute pulmonary embolism.
abstract: Bleeding-prediction scores may help guiding management of patients with pulmonary embolism (PE), although no such score has been validated. We aimed to externally validate and compare two bleeding-prediction scores for venous thromboembolism to three scores developed for patients with atrial fibrillation in a real-world cohort of PE patients. We performed a prospective observational cohort study in 448 consecutive PE patients who were treated with heparins followed by vitamin-K-antagonists. The Kuijer, RIETE, HEMORR2HAGES, HAS-BLED and ATRIA scores were assessed at baseline. All patients were followed for the occurrence of major bleeding over a 30-day period. The accuracies of both the overall, original 3-level and newly defined optimal 2-level outcome of the scores were evaluated and compared, both for the 30-day period as well as for bleeding occurring in versus after the first week of treatment. 20 of 448 patients suffered major bleeding resulting in a cumulative incidence of 4.5 % (95 % CI 2.5-6.5). The predictive power of all five scores for bleeding was poor (c-statistics 0.57-0.64), both for the 3-level and 2-level score outcomes. No individual score was found to be superior. The HAS-BLED score had a good c-statistic for bleedings occurring after the first week of treatment (0.75, 95 % CI 0.47-1.0). Current available scoring systems have insufficient accuracy to predict overall anticoagulation-associated bleeding in patients treated for acute PE. To optimally target bleeding-prevention strategies, the development of a high quality PE-specific risk score is urgently needed.
authors.affiliation: Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Johannes Gutenberg University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.
authors.forename: F A
authors.initials: FA
authors.lastname: Klok
authors.affiliation: Clinic for Cardiology and Pulmonology, Heart Center, University of Göttingen, Göttingen, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Niemann
authors.affiliation: Department of Paediatric Cardiology, Heart Center, University of Göttingen, Göttingen, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Dellas
authors.affiliation: Clinic for Cardiology and Pulmonology, Heart Center, University of Göttingen, Göttingen, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Hasenfuß
authors.affiliation: Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Johannes Gutenberg University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Konstantinides
authors.affiliation: Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Johannes Gutenberg University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany. mareike.lankeit@unimedizin-mainz.de.|Clinic for Cardiology and Pulmonology, Heart Center, University of Göttingen, Göttingen, Germany. mareike.lankeit@unimedizin-mainz.de.
authors.forename: M
authors.initials: M
authors.lastname: Lankeit
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006470:Hemorrhage / Q000097:blood / Q000139:chemically induced / Q000401:mortality; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000097:blood / Q000188:drug therapy / Q000401:mortality; D012042:Registries; D018570:Risk Assessment; D014812:Vitamin K / Q000037:antagonists & inhibitors*
chemical_list: D014812:Vitamin K; D006493:Heparin
keywords: Atrial fibrillation; Bleeding; Prevention; Pulmonary embolism; Risk score