Risk Score to Predict Serious Bleeding in Stable Outpatients with or at Risk of Atherothrombosis
Date
2010-02-24
Authors
Ducrocq, Gregory
Wallace, Joshua S.
Baron, Gabriel
Ravaud, Philippe
Alberts, Mark J.
Wilson, Peter W.F.
Ohman, Erik Magnus
Brennan, Danielle M.
D'Agostino, Ralph B.
Bhatt, Deepak L.
Version
OA Version
Citation
Ducrocq, Gregory, Joshua S. Wallace, Gabriel Baron, Philippe Ravaud, Mark J. Alberts, Peter W.F. Wilson, Erik Magnus Ohman, Danielle M. Brennan, Ralph B. D'Agostino, Deepak L. Bhatt, Philippe Gabriel Steg. "Risk Score to Predict Serious Bleeding in Stable Outpatients with or at Risk of Atherothrombosis" European Heart Journal 31(10): 1257-1265. (2010)
Abstract
AIMS. To develop a risk score to quantify bleeding risk in outpatients with or at risk of atherothrombosis. METHODS AND RESULTS. We studied patients in the REACH Registry, a cohort of 68 236 patients with/at risk of atherothrombosis. The outcome of interest was serious bleeding (non-fatal haemorrhagic stroke or bleeding leading to hospitalization and transfusion) over 2 years. Risk factors for bleeding were assessed using modified regression analysis. Multiple potential scoring systems based on the least complex models were constructed. Competing scores were compared on their discriminative ability via logistic regression. The score was validated externally using the CHARISMA population. From a final cohort of 56 616 patients, 804 (1.42%, 95% confidence interval 1.32-1.52) experienced serious bleeding between baseline and 2 years. A nine-item bleeding risk score (0-23 points) was constructed (age, peripheral arterial disease, congestive heart failure, diabetes, hypertension, smoking, antiplatelets, oral anticoagulants, hypercholesterolaemia). Observed incidence of bleeding at 2 years was: 0.46% (score ≤6); 0.95% (7-8); 1.25% (9-10); 2.76% (≥11). The score's discriminative performance was consistent in CHARISMA and REACH (c-statistics 0.64 and 0.68, respectively); calibration in the CHARISMA population was very good (modified Hosmer-Lemeshow c2 = 4.74; P = 0.69). CONCLUSION. Bleeding risk increased substantially with a score >10. This score can assist clinicians in predicting the risk of serious bleeding and making decisions on antithrombotic therapy in outpatients.
Description
License
Published on behalf of the European Society of Cardiology. All rights reserved. Copyright The Author 2010. For permissions please email: journals.permissions@oxfordjournals.org The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that the original authorship is properly and fully attributed; the Journal, Learned Society and Oxford University Press are attributed as the original place of publication with correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org