Save
The American College of Chest Physician score to assess the risk of bleeding during anticoagulation in patients with venous thromboembolism
Author(s): ,
G. Palareti
Affiliations:
Arianna Anticoagulazione Foundation, Bologna, Italy
Correspondence: Gualtiero Palareti, Arianna Anticoagulazione Foundation, Via Paolo Fabbri 1/3, 40138 Bologna, Italy|Tel.: +39 051 341471.|E‐mail: gualtiero.palareti@unibo.it
,
E. Antonucci
Affiliations:
Arianna Anticoagulazione Foundation, Bologna, Italy
,
D. Mastroiacovo
Affiliations:
Angiology Unit, SS Filippo and Nicola Hospital, Avezzano, Italy
,
W. Ageno
Affiliations:
Department of Internal Medicine, University of Insubria, Varese, Italy
,
V. Pengo
Affiliations:
Cardiology Clinic, Thrombosis Centre, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
,
D. Poli
Affiliations:
Thrombosis Centre, AOU Careggi, Firenze, Italy
,
S. Testa
Affiliations:
Hemostasis and Thrombosis Center, Department of Laboratory Medicine, AO Istituti Ospitalieri, Cremona, Italy
,
A. Tosetto
Affiliations:
Hematology Department, S. Bortolo Hospital, Vicenza, Italy
P. Prandoni
Affiliations:
Department of Clinical Medicine, University of Padua, Padua, Italy
ISTH Academy. Palareti G. Oct 4, 2018; 234153
Gualtiero Palareti
Gualtiero Palareti

Access to Premium content is currently a membership benefit.


Click here to join ISTH or renew your membership.

Journal Abstract
Discussion Forum (0)
Rate & Comment (0)


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 an inception cohort of 2263 patients on long‐term anticoagulation (1522 treated with vitamin K antagonists [VKAs] and the remaining with direct oral anticoagulants [DOACs]) belonging to the Italian START2 Register.
Results
More than half the patients were categorized as high risk; nevertheless, a higher proportion received anticoagulation for > 1 year compared with those in the low‐risk category. For 3130 years (median 12 [interquartile range 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‐statistic of the 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%/year) than afterwards (1.2%/year; relative risk (RR), 2.5 [1.3–4.7]), and similar among the three categories. The 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%/year vs. 1.4%/year, respectively).
Conclusion
The bleeding rate during extended treatment was rather low in our patients. ACCP score had insufficiently predictive value for bleeding and cannot be used to guide decisions on extended treatment. New prediction tools for bleeding risk during anticoagulant treatments (including DOACs) are required.
Keyword(s)
anticoagulation, bleeding, direct oral anticoagulant, venous thromboembolism, vitamin K antagonist
Code of conduct/disclaimer available in General Terms & Conditions
Anonymous User Privacy Preferences

Strictly Necessary Cookies (Always Active)

MULTILEARNING platforms and tools hereinafter referred as “MLG SOFTWARE” are provided to you as pure educational platforms/services requiring cookies to operate. In the case of the MLG SOFTWARE, cookies are essential for the Platform to function properly for the provision of education. If these cookies are disabled, a large subset of the functionality provided by the Platform will either be unavailable or cease to work as expected. The MLG SOFTWARE do not capture non-essential activities such as menu items and listings you click on or pages viewed.


Performance Cookies

Performance cookies are used to analyse how visitors use a website in order to provide a better user experience.



Google Analytics is used for user behavior tracking/reporting. Google Analytics works in parallel and independently from MLG’s features. Google Analytics relies on cookies and these cookies can be used by Google to track users across different platforms/services.


Save Settings