title: Validation of the International Medical Prevention Registry on Venous Thromboembolism Bleeding Risk Score.
abstract: BACKGROUND
  Recent guidelines recommend assessing medical inpatients for bleeding risk prior to providing chemical prophylaxis for VTE. The International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) bleeding risk score (BRS) was derived from a well-defined population of medical inpatients but it has not been validated externally. We sought to externally validate the IMPROVE BRS.
  
  
  METHODS
  We prospectively collected characteristics on admission and VTE prophylaxis data each hospital day for all patients admitted for a medical illness to the Walter Reed Army Medical Center over an 18-month period. We calculated the IMPROVE BRS for each patient using admission data and reviewed medical records to identify bleeding events.
  
  
  RESULTS
  From September 2009 through March 2011, 1,668 inpatients met the IMPROVE inclusion criteria. Bleeding events occurred during 45 separate admissions (2.7%); 31 events (1.9%) were major and 14 (0.8%) were nonmajor but clinically relevant. Two hundred fifty-six patients (20.7%) had an IMPROVE BRS ≥ 7.0. Kaplan-Meier curves showed a higher cumulative incidence of major (P = .02) and clinically important (major plus clinically relevant nonmajor) (P = .06) bleeding within 14 days in patients with an IMPROVE BRS ≥ 7.0. An IMPROVE BRS ≥ 7.0 was associated with major bleeding in Cox-regression analysis adjusted for administration of chemical prophylaxis (OR, 2.6; 95% CI, 1.1-5.9; P = .03); there was a trend toward a significant association with clinically important bleeding (OR, 1.9; 95% CI, 0.9-3.7; P = .07).
  
  
  CONCLUSIONS
  The IMPROVE BRS calculated at admission predicts major bleeding in medical inpatients. This model may help assess the relative risks of bleeding and VTE before chemoprophylaxis is administered.
authors: Department of Pulmonary and Critical Care Medicine, Walter Reed National Military Medical Center, Bethesda, MD.
authors: David C
authors: DC
authors: Hostler
authors: Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD.
authors: Elizabeth S
authors: ES
authors: Marx
authors: Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD.
authors: Lisa K
authors: LK
authors: Moores
authors: Department of Pulmonary and Critical Care Medicine, Walter Reed National Military Medical Center, Bethesda, MD.
authors: Sarah K
authors: SK
authors: Petteys
authors: Department of Pulmonary, Critical Care, and Sleep Medicine, Walter Reed National Military Medical Center, Bethesda, MD.
authors: Jordanna Mae
authors: JM
authors: Hostler
authors: Department of Internal Medicine, Walter Reed National Military Medical Center, Bethesda, MD.
authors: Joshua D
authors: JD
authors: Mitchell
authors: Department of Informatics, US Army Medical Research Institute of Infectious Diseases, Frederick, MD.
authors: Paul R
authors: PR
authors: Holley
authors: Department of Pulmonary and Critical Care Medicine, San Antonio Military Medical Center, San Antonio, TX.
authors: Jacob F
authors: JF
authors: Collen
authors: Department of Internal Medicine, Walter Reed National Military Medical Center, Bethesda, MD.
authors: Brian E
authors: BE
authors: Foster
authors: Department of Pulmonary, Critical Care, and Sleep Medicine, Walter Reed National Military Medical Center, Bethesda, MD. Electronic address: aholley9@gmail.com.
authors: Aaron B
authors: AB
authors: Holley
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006470:Hemorrhage / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007297:Inpatients; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries / Q000592:standards*; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000175:diagnosis* / Q000517:prevention & control
chemical_list: D000925:Anticoagulants
keywords: antibiotic therapy; deep venous thrombosis; pulmonary embolism