OC 52.2 - Risk of bleeding and performance of bleeding risk scores in patients with venous thromboembolism on anticoagulation: Results from a prospective cohort study

Tuesday, June 25, 2024

09:45 – 10:00 ICT

Room: Ballroom B2

Presenting Author(s)

Timothy Hoberstorfer, MD

PhD student
Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna
Vienna, Wien, Austria

Co-Author(s)

Daniel Steiner

PhD student
Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna
Vienna, Wien, Austria
Stephan Nopp

Physician
Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna
Vienna, Wien, Austria
OS

Oliver Schlager

Professor
Division of Angiology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
Vienna, Wien, Austria
Ingrid Pabinger

Professor
Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna
Vienna, Wien, Austria
BW

Benedikt Weber

Professor
Department of Dermatology, Medical University of Vienna, Vienna, Austria
Vienna, Wien, Austria
Cihan Ay, MD

Professor
Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna
Vienna, Wien, Austria

Background: Patients with venous thromboembolism (VTE) on anticoagulation are at risk of bleeding. While bleeding risk scores can guide clinical decision-making on the duration of anticoagulation, their performance in real-world cohorts remains unclear.

Aims: To evaluate bleeding risk and assess performance of bleeding risk scores (HAS-BLED, RIETE, and VTE-BLEED) in anticoagulated patients with VTE.

Methods: We conducted a prospective cohort study at the Medical University of Vienna, including patients within 21 days from VTE diagnosis. Informed consent was obtained. The study was approved by the university´s ethics committee and funded by the GTH Early Career Research Grant 2023. Exclusion criteria were anticoagulation during the past three months, age < 18 years, active cancer, and pregnancy or puerperium. Anticoagulated patients were followed up for two years. We evaluated incidence rates of major bleeding, clinically relevant non-major bleeding (CRNMB), and minor bleeding. Cumulative incidence of clinically relevant bleeding (CRB; composite of major bleeding and CRNMB) was calculated. Performance of bleeding risk scores was assessed with the area under the receiver operating characteristics curve (AUC-ROC).

Results: We included 263 patients with a median (IQR) age of 54 years (42.5-63), of whom 41.1% were women, 45.6% had pulmonary embolism, 62% had unprovoked VTE, and 97.7% were treated with a direct oral anticoagulant (DOAC). During 203.2 observed patient-years, 2 major bleedings, 35 CRNMBs, and 67 minor bleedings occurred, corresponding to incidence rates of 1, 17.2, and 33 per 100 patient-years, respectively. The 1-year cumulative incidence of CRB was 15.2% (95% CI: 9.7-20.4; Table 1). The ROC-AUC (95% CI) was 0.53 (0.43-0.64) for HAS-BLED, 0.54 (0.43-0.64) for RIETE, and 0.52 (0.4-0.65) for VTE-BLEED (Figure 1).

Conclusion(s): In a real-world setting of anticoagulated patients after VTE, we observed moderate bleeding rates. Existing bleeding risk scores showed a poor performance for CRB. Optimization of bleeding risk assessment in such patients is required.