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

Gregory Ducrocq, 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

Research output: Contribution to journalArticle

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Abstract

AimsTo develop a risk score to quantify bleeding risk in outpatients with or at risk of atherothrombosis.Methods and resultsWe 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.

Original languageEnglish (US)
Pages (from-to)1257-1265
Number of pages9
JournalEuropean Heart Journal
Volume31
Issue number10
DOIs
StatePublished - May 2010

Fingerprint

Outpatients
Hemorrhage
Aptitude
Peripheral Arterial Disease
Hypercholesterolemia
Anticoagulants
Calibration
Population
Registries
Decision Making
Hospitalization
Heart Failure
Logistic Models
Smoking
Stroke
Regression Analysis
Confidence Intervals
Hypertension
Incidence

Keywords

  • Antithrombotic therapy
  • Atherothrombosis
  • Bleeding risk

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Ducrocq, G., Wallace, J. S., Baron, G., Ravaud, P., Alberts, M. J., Wilson, P. W. F., ... Steg, P. G. (2010). Risk score to predict serious bleeding in stable outpatients with or at risk of atherothrombosis. European Heart Journal, 31(10), 1257-1265. https://doi.org/10.1093/eurheartj/ehq021

Risk score to predict serious bleeding in stable outpatients with or at risk of atherothrombosis. / 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.; Steg, Philippe Gabriel.

In: European Heart Journal, Vol. 31, No. 10, 05.2010, p. 1257-1265.

Research output: Contribution to journalArticle

Ducrocq, G, Wallace, JS, Baron, G, Ravaud, P, Alberts, MJ, Wilson, PWF, Ohman, EM, Brennan, DM, D'Agostino, RB, Bhatt, DL & Steg, PG 2010, 'Risk score to predict serious bleeding in stable outpatients with or at risk of atherothrombosis', European Heart Journal, vol. 31, no. 10, pp. 1257-1265. https://doi.org/10.1093/eurheartj/ehq021
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. ; Steg, Philippe Gabriel. / Risk score to predict serious bleeding in stable outpatients with or at risk of atherothrombosis. In: European Heart Journal. 2010 ; Vol. 31, No. 10. pp. 1257-1265.
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AU - Ohman, Erik Magnus

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