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Thromb Haemost 2021; 121(11): 1512-1522
DOI: 10.1055/s-0041-1726345
Stroke, Systemic or Venous Thromboembolism

Comparison of Bleeding Risk Scores in Elderly Patients Receiving Extended Anticoagulation with Vitamin K Antagonists for Venous Thromboembolism

Andrea N. Frei
1   Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
,
Odile Stalder
2   CTU Bern, University of Bern, Bern, Switzerland
,
Andreas Limacher
2   CTU Bern, University of Bern, Bern, Switzerland
,
Marie Méan
3   Department of General Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
,
Christine Baumgartner
1   Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
,
Nicolas Rodondi
1   Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
4   Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
,
Drahomir Aujesky
1   Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
› Author Affiliations Funding This work was supported by the Swiss National Science Foundation (Grant no. 33CSO-122659/139470).
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Abstract

Background In elderly patients with venous thromboembolism (VTE), the decision to extend anticoagulation beyond 3 months must be weighed against the bleeding risk. We compared the predictive performance of 10 clinical bleeding scores (VTE-BLEED, Seiler, Kuijer, Kearon, RIETE, ACCP, OBRI, HEMORR2HAGES, HAS-BLED, ATRIA) in elderly patients receiving extended anticoagulation for VTE.

Methods In a multicenter Swiss cohort study, we analyzed 743 patients aged ≥65 years who received extended treatment with vitamin K antagonists after VTE. The outcomes were the time to a first major and clinically relevant bleeding. For each score, we classified patients into two bleeding risk categories (low/moderate vs. high). We calculated likelihood ratios and the area under the receiver operating characteristic (ROC) curve for each score.

Results Over a median anticoagulation duration of 10.1 months, 45 patients (6.1%) had a first major and 127 (17.1%) a clinically relevant bleeding. The positive likelihood ratios for predicting major bleeding ranged from 0.69 (OBRI) to 2.56 (Seiler) and from 1.07 (ACCP) to 2.36 (Seiler) for clinically relevant bleeding. The areas under the ROC curves were poor to fair and varied between 0.47 (OBRI) and 0.70 (Seiler) for major and between 0.52 (OBRI) and 0.67 (HEMORR2HAGES) for clinically relevant bleeding.

Conclusion The predictive performance of most clinical bleeding risk scores does not appear to be sufficiently high to identify elderly patients with VTE who are at high risk of bleeding and who may therefore not be suitable candidates for extended anticoagulation.

Keywords

anticoagulants - bleeding - elderly - risk scores - venous thromboembolism

Author Contributions

A.N. Frei and D. Aujesky were responsible for study concept and design. O. Stalder and A. Limacher performed the statistical analyses. A.N. Frei and D. Aujesky wrote the manuscript. O. Stalder, A. Limacher, M. Méan, C. Baumgartner, and N. Rodondi revised the manuscript. M. Méan and D. Aujesky collected the data and obtained funding from the Swiss National Science Foundation.


Supplementary Material



Publication History

Received: 16 November 2020

Accepted: 09 February 2021

Article published online:
30 April 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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