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Risk score to predict serious bleeding in stable outpatients with or at risk of atherothrombosis

AIMS: To develop a risk score to quantify bleeding risk in outpatients with or at risk of atherothrombosis. METHODS AND RESULTS: We studied patients in the REACH Registry, a cohort of 68 236 patients with/at risk of atherothrombosis. The outcome of interest was serious bleeding (non-fatal haemorrhag...

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Autores principales: Ducrocq, Gregory, Wallace, Joshua S., Baron, Gabriel, Ravaud, Philippe, Alberts, Mark J., Wilson, Peter W.F., Ohman, Erik Magnus, Brennan, Danielle M., D'Agostino, Ralph B., Bhatt, Deepak L., Steg, Philippe Gabriel
Formato: Texto
Lenguaje:English
Publicado: Oxford University Press 2010
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2869443/
https://www.ncbi.nlm.nih.gov/pubmed/20181681
http://dx.doi.org/10.1093/eurheartj/ehq021
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author Ducrocq, Gregory
Wallace, Joshua S.
Baron, Gabriel
Ravaud, Philippe
Alberts, Mark J.
Wilson, Peter W.F.
Ohman, Erik Magnus
Brennan, Danielle M.
D'Agostino, Ralph B.
Bhatt, Deepak L.
Steg, Philippe Gabriel
author_facet Ducrocq, Gregory
Wallace, Joshua S.
Baron, Gabriel
Ravaud, Philippe
Alberts, Mark J.
Wilson, Peter W.F.
Ohman, Erik Magnus
Brennan, Danielle M.
D'Agostino, Ralph B.
Bhatt, Deepak L.
Steg, Philippe Gabriel
author_sort Ducrocq, Gregory
collection PubMed
description AIMS: To develop a risk score to quantify bleeding risk in outpatients with or at risk of atherothrombosis. METHODS AND RESULTS: We studied patients in the REACH Registry, a cohort of 68 236 patients with/at risk of atherothrombosis. The outcome of interest was serious bleeding (non-fatal haemorrhagic stroke or bleeding leading to hospitalization and transfusion) over 2 years. Risk factors for bleeding were assessed using modified regression analysis. Multiple potential scoring systems based on the least complex models were constructed. Competing scores were compared on their discriminative ability via logistic regression. The score was validated externally using the CHARISMA population. From a final cohort of 56 616 patients, 804 (1.42%, 95% confidence interval 1.32–1.52) experienced serious bleeding between baseline and 2 years. A nine-item bleeding risk score (0–23 points) was constructed (age, peripheral arterial disease, congestive heart failure, diabetes, hypertension, smoking, antiplatelets, oral anticoagulants, hypercholesterolaemia). Observed incidence of bleeding at 2 years was: 0.46% (score ≤6); 0.95% (7–8); 1.25% (9–10); 2.76% (≥11). The score's discriminative performance was consistent in CHARISMA and REACH (c-statistics 0.64 and 0.68, respectively); calibration in the CHARISMA population was very good (modified Hosmer-Lemeshow c(2) = 4.74; P = 0.69). CONCLUSION: Bleeding risk increased substantially with a score >10. This score can assist clinicians in predicting the risk of serious bleeding and making decisions on antithrombotic therapy in outpatients.
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spelling pubmed-28694432010-05-17 Risk score to predict serious bleeding in stable outpatients with or at risk of atherothrombosis Ducrocq, Gregory Wallace, Joshua S. Baron, Gabriel Ravaud, Philippe Alberts, Mark J. Wilson, Peter W.F. Ohman, Erik Magnus Brennan, Danielle M. D'Agostino, Ralph B. Bhatt, Deepak L. Steg, Philippe Gabriel Eur Heart J Clinical Research AIMS: To develop a risk score to quantify bleeding risk in outpatients with or at risk of atherothrombosis. METHODS AND RESULTS: We studied patients in the REACH Registry, a cohort of 68 236 patients with/at risk of atherothrombosis. The outcome of interest was serious bleeding (non-fatal haemorrhagic stroke or bleeding leading to hospitalization and transfusion) over 2 years. Risk factors for bleeding were assessed using modified regression analysis. Multiple potential scoring systems based on the least complex models were constructed. Competing scores were compared on their discriminative ability via logistic regression. The score was validated externally using the CHARISMA population. From a final cohort of 56 616 patients, 804 (1.42%, 95% confidence interval 1.32–1.52) experienced serious bleeding between baseline and 2 years. A nine-item bleeding risk score (0–23 points) was constructed (age, peripheral arterial disease, congestive heart failure, diabetes, hypertension, smoking, antiplatelets, oral anticoagulants, hypercholesterolaemia). Observed incidence of bleeding at 2 years was: 0.46% (score ≤6); 0.95% (7–8); 1.25% (9–10); 2.76% (≥11). The score's discriminative performance was consistent in CHARISMA and REACH (c-statistics 0.64 and 0.68, respectively); calibration in the CHARISMA population was very good (modified Hosmer-Lemeshow c(2) = 4.74; P = 0.69). CONCLUSION: Bleeding risk increased substantially with a score >10. This score can assist clinicians in predicting the risk of serious bleeding and making decisions on antithrombotic therapy in outpatients. Oxford University Press 2010-05 2010-02-24 /pmc/articles/PMC2869443/ /pubmed/20181681 http://dx.doi.org/10.1093/eurheartj/ehq021 Text en Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2010. For permissions please email: journals.permissions@oxfordjournals.org http://creativecommons.org/licenses/by-nc/2.0/uk/ The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that the original authorship is properly and fully attributed; the Journal, Learned Society and Oxford University Press are attributed as the original place of publication with correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org
spellingShingle Clinical Research
Ducrocq, Gregory
Wallace, Joshua S.
Baron, Gabriel
Ravaud, Philippe
Alberts, Mark J.
Wilson, Peter W.F.
Ohman, Erik Magnus
Brennan, Danielle M.
D'Agostino, Ralph B.
Bhatt, Deepak L.
Steg, Philippe Gabriel
Risk score to predict serious bleeding in stable outpatients with or at risk of atherothrombosis
title Risk score to predict serious bleeding in stable outpatients with or at risk of atherothrombosis
title_full Risk score to predict serious bleeding in stable outpatients with or at risk of atherothrombosis
title_fullStr Risk score to predict serious bleeding in stable outpatients with or at risk of atherothrombosis
title_full_unstemmed Risk score to predict serious bleeding in stable outpatients with or at risk of atherothrombosis
title_short Risk score to predict serious bleeding in stable outpatients with or at risk of atherothrombosis
title_sort risk score to predict serious bleeding in stable outpatients with or at risk of atherothrombosis
topic Clinical Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2869443/
https://www.ncbi.nlm.nih.gov/pubmed/20181681
http://dx.doi.org/10.1093/eurheartj/ehq021
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