TABLE 2.
Overview of bleeding risk prediction models developed for or tested in VTE patients
| Model | Number of variables | Outcome | External evaluation | Evaluation in subgroups | Time period | Anticoagulants | Definition of major bleeding | |||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Retrospective | Prospective | Overall | Unprovoked | Cancer | Elderly | First 3 months | Beyond 3 months | VKA | Anti‐Xa | Anti‐IIa | ||||
| VTE‐BLEED | 6 | 2‐level | 43, 44, 45, 46, 47 | 35, 36, 48, 49, 50, 51 | X | X | X | X | X | X | X | X | ISTH major bleeding | |
| RIETE | 6 | 3‐level | 33, 34, 46, 47, 52, 53, 54, 55, 56 | 36, 51, 57, 58 | X | X | X | X | X | X | X | Investigator‐reported overt bleeding requiring transfusion of ≥2 units of blood, intracranial or retroperitoneal or spinal location, or leading to death | ||
| Nieuwenhuis | 4 | 3‐level | 56, 59 | ‐‐ | X | X | X | Bleeding that leads to death, to interruption of treatment, to blood transfusion, or to a decrease in hemoglobin level of >2.42 g/dl | ||||||
| Seiler | 7 | 3‐level | ‐ | ‐ | X | X | X | X | ISTH major bleeding | |||||
| Einstein score | 3 different models proposed | No threshold provided | 41 | ‐ | X | X | Median 183 days | X | X | ISTH major bleeding | ||||
| Hokusai score | 5 | No threshold provided | ‐ | ‐ | X | X | Median 267 days | X | X | ISTH major bleeding | ||||
| Martinez | 15 | 2‐level | ‐ | ‐ | X | X | X | ISTH major bleeding | ||||||
| Kuijer | 3 | 3‐level | 33, 41, 47, 52, 53, 54, 55, 56 | 19, 57, 58, 60 | X | X | X | X | X | X | X | ≥2 g/dl drop in hemoglobin, requiring transfusion of ≥2 units of blood, intracranial or retroperitoneal location, or warranting permanent treatment discontinuation | ||
| ACCP risk table | 18 | 3‐level | 33, 34, 41, 55, 56 | 32, 48, 58 | X | X | X | X | X | No derivation study | ||||
| HAS‐BLED | 7 | 3‐level | 34, 41, 43, 46, 47, 52, 54, 61 | 30, 31, 48, 58 | X | X | X | X | X | X | X | Any bleeding requiring hospitalization and/or causing a decrease in hemoglobin level of >2 g/L and/or requiring blood transfusion that was not a hemorrhagic stroke. | ||
| HEMORR2‐HAGES | 11 | 2‐level | 34, 46, 52, 54 | 58 | X | X | X | X | X | X | X | Hospitalization for hemorrhage, as determined by Medicare claims. | ||
| ATRIA | 5 | 3‐level | 34, 47 | 58 | X | X | X | X | X | X | X | Fatal bleeding, bleeding requiring transfusion of ≥2 U packed blood cells, or bleeding into a critical anatomic site (e.g., intracranial, retroperitoneal). | ||
| Shireman | 8 | 3‐level | ‐ | 58 | X | X | X | X | Hospitalization for GI bleed or intracranial bleed | |||||
| ORBIT | 5 | 3‐level | 41, 47 | ‐ | X | X | X | X | ISTH major bleeding | |||||
| Landefeld and Goldman | 5 | 3‐level | 53, 59 | 57 | X | X | X | X | Bleeding that is (1) fatal, (2) life‐threatening, (3) potentially life‐threatening, (4) led to severe blood loss, (5) led to surgical treatment, or (6) led to moderate blood loss that was acute or subacute, not explained by trauma or surgery | |||||
| mOBRI (Beyth) | 4 | 3‐level | 33, 34, 41, 52, 53, 62 | 57, 58 | X | X | X | X | X | X | X | Overt bleeding that led to the loss of at least 2.0 units in 7 days or less, or was otherwise life‐threatening (e.g., intracranial bleeding) | ||
| PE‐SCARD | 3 | 3‐level | ‐ | ‐ | X | X | ISTH major bleeding | |||||||
Abbreviations: ACCP, American College of Chest Physicians; GI, gastrointestinal; ISTH, International Society on Thrombosis and Haemostasis; HAS‐BLED, Hypertension/Abnormal liver or renal function/Stroke/Bleeding/Labile INR/Elderly/Drugs or Alcohol; mOBRI, Modified Outpatient Bleeding Risk Index; ORBIT, Outcomes Registry for Better Informed Treatment; PE‐SCARD, Pulmonary Embolism Syncope, Anemia, Renal Dysfunction; RIETE, Registro Informatizado de Enfermedad Tromboembolico; VTE, venous thromboembolism; VTE‐BLEED, Venous Thromboembolic Disease & Bleeding.