Table 6.
Major bleeding prediction models in VTE patients
| Score Author, year |
Bleeding risk factors included | High risk scoring and MB incidence |
|---|---|---|
| Nieuwenhuis [124], 1991 | WHO performance status grade 2: 1 pt; WHO grade 3 or 4: 2 pts; history of a bleeding diathesis: 2 pts; recent (< 2 months) trauma or surgery: 1 pt; BSA < 2 m2: 2 pts | ≥ 5 = 44% at 8 daysa |
|
OBRI Beyth [117], 1998 |
Age ≥ 65 yrs, history of GIB, previous stroke, co-morbidities (recent MI, hematocrit < 30%, diabetes, creatinine > 1.5 mg/dL): 1 pt each | ≥ 3 = 53% at 48 months |
| Kuijer [125], 1999 | Age ≥ 60 yrs, F sex, BSA ≤ 2, malignancy, long-acting coumarin (1 pt each, otherwise 0 points). Score = (1.6 × age) + (1.3 × sex) + (2.2 × malignancy) + (2.4 × BSA) + (1.3 × coumarin type) | ≥ 6.25 = 7% at 3 months |
|
HEMORR2HAGES Gage [118], 2006 |
Prior bleed (2 pts). Liver/renal disease, ethanol abuse, malignancy, age > 75 yrs, low platelet count or function, uncontrolled hypertension, anemia, genetic factors (CYP2C9), risk of fall, stroke (1 pt each) | ≥ 4 = 10.4% annually |
|
RIETE Ruíz-Gimenez [126], 2008 |
Recent MB: 2 pts; creatinine levels > 1.2 mg/dL, anemia: 1.5 pts each; cancer, clinically overt PE, age > 75 yrs: 1 pt each | ≥ 5 = 6.2% at 3 months |
|
ATRIA Fang [119], 2011 |
Anemia, renal disease (eGFR < 30 ml/min): 3 pts each; age ≥ 75 years: 2 pts; any prior bleeding, hypertension: 1 pt each | ≥ 5 = 5.8% annually |
|
ACCP Kearon [127], 2012 |
Age > 65 years, previous bleeding, active/metastatic cancer, renal failure, liver failure, thrombocytopenia, previous stroke, diabetes, anemia, antiplatelet therapy, poor AC control therapy, comorbidity and reduced functional capacity, recent surgery, frequent falls, NSAIDs, alcohol abuse: 1 pt each | ≥ 2 = 12.8% 0–3 months; ≥ 6.5% annually |
|
VTE-BLEED (XALIA register) Klok [128], 2016 |
Active cancer: 2 pts; male with uncontrolled hypertension: 1 pt; anemia (Hb < 13 g/dL M or < 12 g/dL F): 1.5 pts; history of bleeding: 1.5 pts; age ≥ 60 years: 1.5 pt; eGRF 30–60 ml/min: 1.5 pts | ≥ 2 = 12.6% at 6 months |
AC anticoagulant, BSA body surface area, CYP2C9 cytochrome P450 2C9, eGFR estimated glomerular filtration rate, F female, GIB gastrointestinal bleeding, Hb hemoglobin, M male, MB major bleeding, MI myocardial infarction, NSAIDs nonsteroidal antiinflammatory drugs, pt point, WHO world health organization
aInitial VTE treatment with heparin or dalteparin