Major bleeding occurred in 3.1% of acute PE patients; thrombolysis increased risk to 9.3%. Active cancer, prior bleeding, anemia predicted late bleeding, and phenotyping improved risk stratification.
What are the independent predictors and phenotypic clusters for early and late major bleeding within 30 days in patients with acute pulmonary embolism?
In patients with acute pulmonary embolism, risk factors for early and late major bleeding differ, and phenotypic clustering may improve bleeding risk stratification compared to traditional clinical scores.
Absolute Event Rate: 0% vs 0%
Abstract Background In patients with acute pulmonary embolism (PE), major bleeding (MB) is the counterbalance for anticoagulant and thrombolytic treatment. In patients with acute, symptomatic PE from a prospective, multicentre study (COPE), we aimed to assess independent predictors, evaluate the performance of currently available scores and identify phenotypic clusters for prediction of MB. Methods The primary outcome was MB during 30-day follow-up. MB was defined according to ISTH. MBs were classified as early (7 days) and late (≥7 days) based on days from PE diagnosis. Results Among 5,213 patients with acute PE, 159 experienced MB (3.1%), 78 as early and 81 as late events. MB were intracranial haemorrhage in 17 (0.3%), fatal in 6 and required transfusion 2 RBC unit and/or Hb drop ≥2g/dl in 138 patients (2.6%). MB occurred in 9.3% and 2.5% of patients receiving and not receiving thrombolysis. Active cancer, previous bleeding, dementia, anemia, syncope and thrombolysis were independent predictors of MB at 30 days and of early MB; only active cancer, previous bleeding and anemia were independent predictors of late MB. The PE-SARD, the BACS and VTE-Bleed scores had better performance in predicting early than late MBs and modest performance in predicting thrombolysis-associated MB. Four phenotypic clusters of patients were identified with different risk for MB; A= old patients with low prevalence of comorbidities, B=old patients with comorbidities and intermediate or high-risk PE, C= middle-aged patients with cancer or and D= young patients with low prevalence of comorbidities. Conclusions In patients with acute PE, risk factors for early and late MB within 30 days differ. Compared to stratification strategies solely based on bleeding predictors, phenotyping can offer better accuracy in identifying patients at risk for MB.
Becattini et al. (Sat,) reported a other. Major bleeding occurred in 3.1% of acute PE patients; thrombolysis increased risk to 9.3%. Active cancer, prior bleeding, anemia predicted late bleeding, and phenotyping improved risk stratification.