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CC BY 4.0 · TH Open 2021; 05(03): e319-e328
DOI: 10.1055/s-0041-1729171
Original Article

Prediction of Major Bleeding in Anticoagulated Patients for Venous Thromboembolism: Comparison of the RIETE and the VTE-BLEED Scores

Ramón Lecumberri
1   Hematology Service, Clínica Universidad de Navarra, IdISNA, Pamplona; CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
,
Laura Jiménez
2   Deparment of Internal Medicine, Hospital Virgen de la Luz, Cuenca, Spain
,
Pedro Ruiz-Artacho
3   Deparment of Internal Medicine, Interdisciplinar Teragnosis and Radiosomics Research Group (INTRA-Madrid), Instituto de Salud Carlos III, University of Navarra, Clínica Universidad de Navarra, CIBERES, Madrid, Spain
,
José Antonio Nieto
2   Deparment of Internal Medicine, Hospital Virgen de la Luz, Cuenca, Spain
,
Nuria Ruiz-Giménez
4   Department of Internal Medicine, Hospital Universitario de La Princesa, Madrid, Spain
,
Adriana Visonà
5   Department of Vascular Medicine, Ospedale Castelfranco Veneto, Castelfranco Veneto, Italy
,
Andris Skride
6   Department of Cardiology, Ospedale Pauls Stradins Clinical University Hospital, Riga Stradiņš University, Riga, Latvia
,
Fares Moustafa
7   Department of Emergency, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
,
Javier Trujillo
8   Department of Internal Medicine, Hospital General Universitario Santa Lucía, Universidad Católica de Murcia, Murcia, Spain
,
Manuel Monreal
9   Department of Internal Medicine, Instituto de Salud Carlos III, Universidad Católica de Murcia, Hospital Germans Trias i Pujol, CIBERES, Badalona (Barcelona), Madrid, Spain
,
for the RIETE investigators › Author Affiliations
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Abstract

The performance of validated bleeding risk scores in patients with venous thromboembolism (VTE) could be different depending on the time after index event or the site of bleeding. In this study we compared the “classic” Registro Informatizado de Enfermedad TromboEmbólica (RIETE) score and the more recently developed VTE-BLEED score for the prediction of major bleeding in patients under anticoagulant therapy in different time intervals after VTE diagnosis. Out of 82,239 patients with acute VTE, the proportion of high-risk patients according to the RIETE and VTE-BLEED scores was 7.1 and 62.3%, respectively. The performance of both scores across the different study periods (first 30 days after VTE diagnosis, days 31–90, days 91–180, and days 181–360) was similar, with areas under the receiving operating characteristics (ROC) curve (AUC) ranging between 0.69 and 0.72. However, the positive predictive values were low, ranging between 0.6 and 3.9 (better for early major bleeding than for later periods). A sensitivity analysis limited to patients with unprovoked VTE showed comparable results. Both scores showed a trend toward a better prediction of extracranial than intracranial major bleeding, the RIETE score resulting more useful for early extracranial bleeding and the VTE-BLEED for late intracranial hemorrhages. Our study reveals that the usefulness of available bleeding scores may vary depending on the characteristics of the patient population and the time frame evaluated. Dynamic scores could be more useful for this purpose.

Keywords

venous thromboembolism - anticoagulation - bleeding - hemorrhage - score

Authors' Contribution

R.L., J.A.N., and M.M. were involved in study design, data collection and interpretation, writing and critical review, and final approval of the manuscript. L.J. was involved in data collection, data analysis and interpretation, writing and critical review, and final approval of the manuscript. All other authors were involved in data collection and interpretation, writing and critical review, and final approval of the manuscript.


* A full list of the RIETE investigators is given in the appendix.


Supplementary Material



Publication History

Received: 06 January 2021

Accepted: 16 March 2021

Article published online:
09 August 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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