Comparison of Four Bleeding Risk Scores to Identify Rivaroxaban-treated Patients With Venous Thromboembolism at Low Risk for Major Bleeding

Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine
Jeffrey A KlinePhilip S Wells

Abstract

Outpatient treatment of acute venous thromboembolism (VTE) requires the selection of patients with a low risk of bleeding during the first few weeks of anticoagulation. The accuracy of four systems, originally derived for predicting bleeding in VTE treated with vitamin K antagonists (VKAs), was assessed in VTE patients treated with rivaroxaban. All patients treated with rivaroxaban in the multinational EINSTEIN deep vein thrombosis (DVT) and pulmonary embolism (PE) trials were included. Major bleeding was defined as ≥2 g/dL drop in hemoglobin or ≥2-unit blood transfusion, bleeding in critical area, or bleeding contributing to death. The authors examined the incidence of major bleeding in patients with low-risk assignment by the systems of Ruiz-Gimenez et al. (score = 0 to 1), Beyth et al. (score = 0), Kuijer et al. (score = 0), and Landefeld and Goldman. (score = 0). For clinical relevance, the definition of low risk for all scores except Kuijer includes all patients < 65 years with no prior bleeding history and no comorbid conditions (current cancer, renal insufficiency, diabetes mellitus, anemia, prior stroke, or myocardial infarction). A total of 4,130 patients (1,731 with DVT only, 2,399 with PE with or without DVT) were tr...Continue Reading

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References

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Feb 20, 2015·Annals of the American Thoracic Society·David R VinsonUNKNOWN Kaiser Permanente Clinical Research on Emergency Services and Treatment (CREST) Network
Jun 27, 2015·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Daren M BeamJeffrey A Kline

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Citations

Feb 1, 2018·Journal of Thrombosis and Thrombolysis·Amir KupermanUNKNOWN RIETE Investigators
Apr 20, 2018·American Journal of Respiratory and Critical Care Medicine·Parth M Rali, Gerard J Criner
Jan 18, 2018·Pediatric Emergency Care·Julieta WeirtheinMiguel Glatstein
Jun 29, 2017·Internal and Emergency Medicine·Francesco Dentali, Chiara Fantoni
Sep 11, 2020·The Annals of Pharmacotherapy·Adesola AdedejiJustin P Reinert
Feb 25, 2021·Hämostaseologie·Stephan Nopp, Cihan Ay
Apr 13, 2021·Postgraduate Medicine·William B Stubblefield, Jeffrey A Kline

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