Document Detail

Bleeding Risk Index in an anticoagulation clinic. Assessment by indication and implications for care.
MedLine Citation:
PMID:  16307625     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The Outpatient Bleeding Risk Index (BRI) prospectively classified patients who were at high, intermediate, or low risk for warfarin-related major bleeding. However, there are only 2 published validation studies of the index and neither included veterans. OBJECTIVE: To determine the accuracy of the BRI in patients attending a Veterans Affairs (VA) anticoagulation clinic and to specifically evaluate the accuracy of the BRI in patients with atrial fibrillation. DESIGN: Retrospective cohort study. PATIENTS AND MEASUREMENTS: Using the BRI, all patients managed by the Anticoagulation Clinic between January 1, 2001 and December 31, 2002 were classified as high, intermediate, or low risk for major bleeding. Bleeds were identified via quality-assurance reports. Poisson regression was used to determine whether there was an association between the index and the development of bleeding. RESULTS: The rate of major bleeding was 10.6%, 2.5%, and 0.8% per patient-year of warfarin in the high-, intermediate-, and low-risk groups, respectively. Patients in the high-risk category had 14 times the rate of major bleeding of those in the low-risk group (incidence rate ratio (IRR) 14; 95% confidence interval (CI), 1.9 to 104.7). The rate of major bleeding was significantly different between the high- and intermediate-risk categories (P<.001). Among those with atrial fibrillation, patients in the high-risk category had 6 times the major bleeding rate of those in the intermediate- and low-risk groups combined (IRR=6; 95% CI, 2.4 to 15.3). CONCLUSIONS: The BRI discriminates between high- and intermediate-risk patients in a VA anticoagulation clinic, including those with atrial fibrillation.
Sherrie L Aspinall; Beth E DeSanzo; Lauren E Trilli; Chester B Good
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Publication Detail:
Type:  Evaluation Studies; Journal Article    
Journal Detail:
Title:  Journal of general internal medicine     Volume:  20     ISSN:  1525-1497     ISO Abbreviation:  J Gen Intern Med     Publication Date:  2005 Nov 
Date Detail:
Created Date:  2005-11-25     Completed Date:  2006-05-04     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  8605834     Medline TA:  J Gen Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1008-13     Citation Subset:  IM    
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA 15240, USA.
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MeSH Terms
Anticoagulants / adverse effects*
Atrial Fibrillation / drug therapy
Cohort Studies
Decision Support Techniques
Hemorrhage / epidemiology*,  etiology,  prevention & control
Poisson Distribution
Retrospective Studies
Risk Assessment
Risk Factors
Sensitivity and Specificity
Warfarin / adverse effects*
Reg. No./Substance:
0/Anticoagulants; 81-81-2/Warfarin
Comment In:
Evid Based Med. 2006 Aug;11(4):120   [PMID:  17213133 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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