Predicting the risk for major bleeding in elderly patients with venous thromboembolism using the Charlson index. Finding
- PDF / 1,024,488 Bytes
- 9 Pages / 595.276 x 790.866 pts Page_size
- 88 Downloads / 176 Views
Predicting the risk for major bleeding in elderly patients with venous thromboembolism using the Charlson index. Findings from the RIETE Covadonga Gómez‑Cuervo1 · Agustina Rivas2 · Adriana Visonà3 · Nuria Ruiz‑Giménez4 · Ángeles Blanco‑Molina5 · Inmaculada Cañas6 · José Portillo7 · Patricia López‑Miguel8 · Katia Flores9 · Manuel Monreal10 · the RIETE Investigators Accepted: 2 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Old patients receiving anticoagulant therapy for venous thromboembolism (VTE) are at an increased risk for bleeding. We used data from the RIETE registry to assess the prognostic ability of the Comorbidity Charlson Index (CCI) to predict the risk for major bleeding in patients aged > 75 years receiving anticoagulation for VTE beyond the third month. We calculated the area under the receiver-operating characteristic curve (AUC), the category-based net reclassification index (NRI) and the net benefit (NB). We included 4303 patients with a median follow-up of 706 days (interquartile range [IQR] 462–1101). Of these, 147 (3%) developed major bleeding (27 died of bleeding). The AUC was 0.569 (95% CI 0.524–0.614). Patients with CCI ≤ 4 points were at a lower risk for adverse outcomes than those with CCI > 10 (major bleeding 0.81 (95% CI 0.53–1.19) vs. 2.21 (95% CI 1.18–3.79) per 100 patient-years; p 75 years diagnosed with pulmonary embolism (PE) or deep vein thrombosis (DVT), who were followed-up at least 1 year, and who were candidates to extended anticoagulation due to an intermediate-high risk for recurrence (patients with VTE after surgery or recent immobilization were not included into the study). We also excluded patients with incomplete data to calculate the CCI or the RIETE bleeding score. We aimed to test the ability of the CCI to identify patients at a high risk of major bleeding during extended anticoagulation. Thus, our analysis was restricted to patients who continued anticoagulation beyond the third month. Since the discontinuation of anticoagulant therapy could be due to concern about its safety, we performed a sensitivity analysis to make sure whether excluded patients differed from those remaining in the cohort. On the other hand, the presence of advanced cancer is an important part of the CCI (6 points for solid, metastatic tumors) and those patients are usually at high risk of complications, including bleeding [14]. To examine any confounding factors related to the weight attributed to advanced cancer in the CCI score, we also performed a sensitivity analysis to address the performance of the CCI to predict major bleeding after the exclusion of those patients.
Data collection and bleeding‑risk scores estimation Besides the usual variables, we adapted the definitions of the items to estimate the CCI (Table 1) and the RIETE bleeding score and at baseline [10]. We recorded mortality, VTE recurrence, and bleeding during follow-up. The definitions of major bleeding, fatal bleeding, and fatal PE have been published elsewhere [13]. Anemia wa
Data Loading...
