Abstract:
:Existing clinical scores do not perform well in predicting bleeding in elderly patients with acute venous thromboembolism (VTE). We sought to derive an easy-to-use clinical score to help physicians identify elderly patients with VTE who are at high-risk of bleeding during extended anticoagulation (>3 months). Our derivation sample included 743 patients aged ≥65 years with VTE who were enrolled in a prospective multicenter cohort study. All patients received extended anticoagulation with vitamin K antagonists. We derived our score using competing risk regression, with the time to a first major bleeding up to 36 months of extended anticoagulation as the outcome, and 17 candidate variables as predictors. We used bootstrapping methods for internal validation. Sixty-six (9 %) patients suffered major bleeding. The clinical score is based on seven clinical factors (previous bleeding, active cancer, low physical activity, anemia, thrombocytopenia, antiplatelet drugs/NSAIDs, and poor INR control). Overall, 48 % of patients were classified as low-risk, 37 % as moderate-risk, and 15 % as high-risk of bleeding. The rate of major bleeding was 1.4 events in low-risk, 5.0 events in moderate-risk, and 12.2 events per 100 patient-years in high-risk patients. The c-statistic was 0.78 at 3 months and 0.71 at 36 months of extended anticoagulation. Model calibration was excellent (p=0.93). Internal validation showed similar results. This simple clinical score accurately identified elderly patients with VTE who are at high risk of major bleeding and who may not benefit from extended anticoagulation. Further validation of the score is important before its implementation into practice. The study is registered to https://clinicaltrials.gov as NCT00973596.
journal_name
Thromb Haemostjournal_title
Thrombosis and haemostasisauthors
Seiler E,Limacher A,Mean M,Beer HJ,Osterwalder J,Frauchiger B,Righini M,Aschwanden M,Matter CM,Banyai M,Kucher N,Staub D,Lämmle B,Rodondi N,Squizzato A,Aujesky Ddoi
10.1160/TH-17-03-0162subject
Has Abstractpub_date
2017-08-24 00:00:00issue
10eissn
0340-6245issn
2567-689Xpii
17-03-0162journal_volume
117pub_type
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journal_title:Thrombosis and haemostasis
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更新日期:1977-10-31 00:00:00
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更新日期:1997-09-01 00:00:00
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journal_title:Thrombosis and haemostasis
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abstract::Fucoïdans catalyse thrombin inhibition by antithrombin (AT) and heparin cofactor II (HCII); their affinity for each serpin varies according to the seaweed species from which they are extracted, as well as their chemical composition and molecular weight. We extracted a homogeneous fucoïdan fraction from Ascophyllum nod...
journal_title:Thrombosis and haemostasis
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更新日期:1995-11-01 00:00:00
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journal_title:Thrombosis and haemostasis
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更新日期:1997-08-01 00:00:00
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journal_title:Thrombosis and haemostasis
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journal_title:Thrombosis and haemostasis
pub_type: 杂志文章,多中心研究
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abstract::Tissue factor pathway inhibitor (TFPI) plays a crucial role in haemostasis by regulating TF-induced initiation of coagulation. Since it is expressed by endothelial and trophoblastic cells, TFPI is of particular importance at the placental level and might be involved in the occurrence of gestational vascular complicati...
journal_title:Thrombosis and haemostasis
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doi:10.1160/TH10-06-0399
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journal_title:Thrombosis and haemostasis
pub_type: 临床试验,杂志文章
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journal_title:Thrombosis and haemostasis
pub_type: 杂志文章,多中心研究
doi:10.1160/TH12-05-0313
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journal_title:Thrombosis and haemostasis
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journal_title:Thrombosis and haemostasis
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doi:
更新日期:1995-07-01 00:00:00
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journal_title:Thrombosis and haemostasis
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doi:
更新日期:1994-10-01 00:00:00
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journal_title:Thrombosis and haemostasis
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journal_title:Thrombosis and haemostasis
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doi:
更新日期:1996-09-01 00:00:00
abstract::Recent experiments have shown that a preparation of PPSB (factor IX concentrate) derived form beta PL/UV treated plasma was not infectious in chimpanzees with respect to hepatitis B and non-A, non-B. To answer the question whether the beta PL/UV treatment influences the tolerance and efficacy of the PPSB-concentrate, ...
journal_title:Thrombosis and haemostasis
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doi:
更新日期:1981-08-28 00:00:00
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journal_title:Thrombosis and haemostasis
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journal_title:Thrombosis and haemostasis
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journal_title:Thrombosis and haemostasis
pub_type: 杂志文章
doi:
更新日期:1992-04-02 00:00:00
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journal_title:Thrombosis and haemostasis
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journal_title:Thrombosis and haemostasis
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更新日期:1989-04-25 00:00:00
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journal_title:Thrombosis and haemostasis
pub_type: 杂志文章,多中心研究,随机对照试验
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journal_title:Thrombosis and haemostasis
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journal_title:Thrombosis and haemostasis
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更新日期:1989-09-29 00:00:00