Document Detail


Fatal bleeding in patients receiving anticoagulant therapy for venous thromboembolism: findings from the RIETE registry.
MedLine Citation:
PMID:  20345727     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Fatal bleeding is a serious consequence of anticoagulant therapy, but factors associated with fatal bleeding during the first 3 months of treatment of venous thromboembolism (VTE) are uncertain.
METHODS: Using data from RIETE, an ongoing registry of consecutive patients with acute VTE, we assessed risk factors for fatal bleeding among all patients. We then used this information to derive a clinical model that would stratify a patient's risk of fatal bleeding during the first 3 months of treatment.
RESULTS: Of 24 395 patients, 546 (2.24%) had a major bleed and 135 (0.55%) had a fatal bleed. The gastrointestinal tract was the most common site (40% of fatal bleeds), followed by intracranial bleeding (25%). Fatal bleeding was independently associated with the following factors at the time of VTE diagnosis: age >75 years (OR, 2.16), metastatic cancer (OR, 3.80), immobility > or = 4 days (OR, 1.99), a major bleed within the past 30 days (OR, 2.64), an abnormal prothrombin time (OR, 2.09), a platelet count < 100 x 10(9) L(-1) (OR, 2.23), creatinine clearance < 30 mL min(-1) (OR, 2.27), anemia (OR, 1.54), and distal deep vein thrombosis (OR, 0.39). INR at the time of bleeding is not known. A clinical prediction rule for risk of fatal bleeding that included nine baseline factors was derived. Fatal bleeding occurred in 0.16% (95% CI, 0.11-0.23) of the low-risk, 1.06% (95% CI, 0.85-1.30) of the moderate-risk, and 4.24% (95% CI, 2.76-6.27) of the high-risk category.
CONCLUSIONS: Patient characteristics and laboratory variables can identify patients at high risk for fatal bleeding during treatment of VTE.
Authors:
J A Nieto; R Solano; M D Ruiz-Ribó; N Ruiz-Gimenez; P Prandoni; C Kearon; M Monreal;
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-03-12
Journal Detail:
Title:  Journal of thrombosis and haemostasis : JTH     Volume:  8     ISSN:  1538-7836     ISO Abbreviation:  J. Thromb. Haemost.     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-08-27     Completed Date:  2010-12-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101170508     Medline TA:  J Thromb Haemost     Country:  England    
Other Details:
Languages:  eng     Pagination:  1216-22     Citation Subset:  IM    
Affiliation:
Servicio de Medicina Interna, Hospital Virgen de la Luz, Cuenca, Spain.
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MeSH Terms
Descriptor/Qualifier:
Aged
Anticoagulants / therapeutic use*
Female
Hemorrhage / mortality*
Humans
Male
Venous Thromboembolism / prevention & control*
Chemical
Reg. No./Substance:
0/Anticoagulants
Investigator
Investigator/Affiliation:
J I Arcelus / ; R Barba / ; A Blanco / ; M Barrón / ; T Bueso / ; I Casado / ; E Cisneros / ; R del Campo / ; F del Molino / ; J del Toro / ; C Delgado / ; M Durán / ; C Falgá / ; C Fernández-Capitán / ; F Gabriel / ; P Gallego / ; F García-Bragado / ; S Gomez-Zorilla / ; S Guijarro / ; M Guil / ; M Gutiérrez J / ; M R Gutiérrez Tous / ; L Hernández / ; D Hernández-Huerta / ; P Jiménez / ; S Jordán / ; R Lecumberri / ; J L Lobo / ; L López / ; A Lorenzo / ; M Llado / ; A Maestre / ; P J Marchena / ; J J Martín-Villasclaras / ; M Monreal / ; M D Nauffal / ; J A Nieto / ; M J Núñez / ; J L Ogea / ; M Oribe / ; J M Pedrajas / ; R Rabuñal / ; A Riera-Mestre / ; P Román / ; V Rosa / ; A Ruíz-Gamietea / ; N Ruíz-Giménez / ; J C Sahuquillo / ; J F Sánchez Muñoz-Torrero / ; R Sánchez / ; S Soler / ; C Soler / ; G Tiberio / ; R Tirado / ; J A Todolí / ; C Tolosa / ; J Trujillo / ; M Valdés / ; V Valdés / ; R Valle / ; M Vahi / ; J Vela / ; J Villalta / ; H Boccalon / ; D Farge-Bancel / ; P Le Corvoisier / ; K Rivron-Guillot / ; B Brenner / ; G Barillari / ; A Barillari / ; M Ciammaichella / ; F Dalla Valle / ; P Di Micco / ; R Duce / ; A Ferrari / ; S Pasca / ; R Poggio / ; P Prandoni / ; R Quintavalla / ; L Rota / ; A Schenone / ; E Tiraferri / ; A Visonà /

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