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. 2010 May;31(10):1257-65.
doi: 10.1093/eurheartj/ehq021. Epub 2010 Feb 24.

Risk score to predict serious bleeding in stable outpatients with or at risk of atherothrombosis

Gregory Ducrocq  1 , 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; REACH Investigators
Affiliations

Risk score to predict serious bleeding in stable outpatients with or at risk of atherothrombosis

Gregory Ducrocq et al. Eur Heart J. 2010 May.

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 < or = 6); 0.95% (7-8); 1.25% (9-10); 2.76% (> or = 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 c(2) = 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.

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Figures

Figure 1
Figure 1
Risk stratification using the score (percentages indicate 2 year risk of serious bleeding).
Figure 2
Figure 2
Calibration plots: observed events in the CHARISMA population vs. events expected using the score.
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References

    1. Hennekens CH. Update on aspirin in the treatment and prevention of cardiovascular disease. Am J Manag Care. 2002;8:S691–S700. - PubMed
    1. Toyoda K, Yasaka M, Iwade K, Nagata K, Koretsune Y, Sakamoto T, Uchiyama S, Gotoh J, Nagao T, Yamamoto M, Takahashi JC, Minematsu K Bleeding with Antithrombotic Therapy (BAT) Study Group. Dual antithrombotic therapy increases severe bleeding events in patients with stroke and cardiovascular disease: a prospective, multicenter, observational study. Stroke. 2008;39:1740–1745. - PubMed
    1. Eikelboom JW, Mehta SR, Anand SS, Xie C, Fox KA, Yusuf S. Adverse impact of bleeding on prognosis in patients with acute coronary syndromes. Circulation. 2006;114:774–782. - PubMed
    1. King SB, III, Smith SC, Jr, Hirshfeld JW, Jr, Jacobs AK, Morrison DA, Williams DO, Feldman TE, Kern MJ, O'Neill WW, Schaff HV, Whitlow PL, Adams CD, Anderson JL, Buller CE, Creager MA, Ettinger SM, Halperin JL, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura R, Page RL, Riegel B, Tarkington LG, Yancy CW. 2007 Focused Update of the ACC/AHA/SCAI 2005 Guideline Update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: 2007 Writing Group to Review New Evidence and Update the ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention, Writing on Behalf of the 2005 Writing Committee. Circulation. 2008;117:261–295. - PubMed
    1. Steinhubl SR, Bhatt DL, Brennan DM, Montalescot G, Hankey GJ, Eikelboom JW, Berger PB, Topol EJ. Aspirin to prevent cardiovascular disease: the association of aspirin dose and clopidogrel with thrombosis and bleeding. Ann Intern Med. 2009;150:379–386. - PubMed

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