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The american college of chest physician score to assess the risk of bleeding during anticoagulation in patients with venous thromboembolism.
J Thromb Haemost. 2018 Jul 30;:
Authors: Palareti G, Antonucci E, Mastroiacovo D, Ageno W, Pengo V, Poli D, Testa S, Tosetto A, Prandoni P
Abstract
BACKGROUND: The American College of Chest Physicians (ACCP) guideline proposes a score to decide on extended anticoagulation after an unprovoked venous thromboembolism (VTE). Methods We investigated the ACCP score to predict bleeding risk in inception cohort of 2263 patients on long-term anticoagulation [1522 treated with vitamin K antagonists (VKAs) and the remaining with direct anticoagulants (DOACs)] belonging to the Italian START2-Register.
RESULTS: More than half patients were categorized at high-risk; nevertheless, they received anticoagulation for > 1 year in higher proportion than those in low-risk category (p = 0.0001). For 3130 years [median 12 (IQR 6,24) months], 48 bleeding outcomes occurred (1.53%/year) in the cohort [1.7%/year and 0.95%/year in high- and low-risk categories, respectively]. The c-statistics of ACCP score was 0.55 (0.48-0.63), 0.50 (0.42-0.58) and 0.56 (0.48-0.64) in low-, moderate- and high-risk categories, respectively. The bleeding incidence was higher during the first 90 days of treatment (3.0%/y) than afterwards [1.2%/y; RR 2.5 (1.3-4.7)], in similar way among the 3 categories. Bleeding rate was not different during the initial 3 months of treatment in patients receiving VKAs or DOACs; it was, however, lower in the latter patients in the subsequent period (0.5%/y vs 1.4%/y, respectively).
CONCLUSION: The bleeding rate during extended treatment was rather low in our patients. ACCP score had insufficiently predictive value for bleeding and can hardly be used to guide decision on extended treatment. New prediction tools for bleeding risk during anticoagulant treatments (including DOACs), are required. This article is protected by copyright. All rights reserved.
PMID: 30059189 [PubMed - as supplied by publisher]