Major gastrointestinal bleeding in patients receiving anticoagulant therapy for venous thromboembolism.
Thromb Res
; 214: 29-36, 2022 06.
Article
em En
| MEDLINE
| ID: mdl-35452869
ABSTRACT
INTRODUCTION:
The gastrointestinal (GI) tract is a frequent site of bleeding in patients receiving anticoagulant therapy for venous thromboembolism (VTE). At-risk patients have not been consistently identified yet.METHODS:
We used the RIETE registry to assess the clinical characteristics of patients developing major GI bleeding during the course of anticoagulation. Then, we built a predictive score based on multivariable analysis, aiming to identify patients at increased risk for major GI bleeding.RESULTS:
We included 87,431 patients with acute VTE. During the course of anticoagulation, 778 (0.89%) suffered major GI bleeding, 815 (0.93%) non-major GI bleeding and 1462 (1.67%) had major bleeding outside the GI tract. During the first 30 days after major GI bleeding, 7.6% of patients re-bled, 3.9% had VTE recurrences and 33% died. On multivariable analysis, male sex, age ≥70 years, initial VTE presentation as pulmonary embolism, active cancer, prior VTE, recent major bleeding in the GI tract, esophageal varicosities, anemia, abnormal prothrombin time, renal insufficiency and use of corticosteroids were associated to an increased risk for major GI bleeding. Using the predictive score, 39,591 patients (45%) were at low risk; 36,602 (42%) at intermediate-risk; 9315 (11%) at high-risk; and 1923 (2.2%) at very high risk. Their rates of major GI bleeding were 0.21%, 0.96%, 2.41% and 6.08%, respectively. The c-statistics was 0.771 (95%CI. 0.755-0.786).CONCLUSIONS:
We have developed a score which has the potential to identify patients at increased risk for GI bleeding, but needs to be externally validated."Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Embolia Pulmonar
/
Tromboembolia Venosa
Tipo de estudo:
Prognostic_studies
Limite:
Aged
/
Humans
/
Male
Idioma:
En
Revista:
Thromb Res
Ano de publicação:
2022
Tipo de documento:
Article