Abstract
Background: Acutely ill, hospitalized medical patients are at risk of VTE. Despite guidelines for VTE prevention, prophylaxis use in these patients is still poor, possibly because of fear of bleeding risk. We used data from the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) to assess in-hospital bleeding incidence and to identify risk factors at admission associated with in-hospital bleeding risk in acutely ill medical patients. Methods: IMPROVE is a multinational, observational study that enrolled 15,156 medical patients. The in-hospital bleeding incidence was estimated by Kaplan-Meier analysis. A multiple regression model analysis was performed to identify risk factors at admission associated with bleeding. Results: The cumulative incidence of major and nonmajor in-hospital bleeding within 14 days of admission was 3.2%. Active gastroduodenal ulcer (OR, 4.15; 95% CI, 2.21-7.77), prior bleeding (OR, 3.64; 95% CI, 2.21-5.99), and low platelet count (OR, 3.37; 95% CI, 1.84-6.18) were the strongest independent risk factors at admission for bleeding. Other bleeding risk factors were increased age, hepatic or renal failure, ICU stay, central venous catheter, rheumatic disease, cancer, and male sex. Using these bleeding risk factors, a risk score was developed to estimate bleeding risk. Conclusions: We assessed the incidence of major and clinically relevant bleeding in a large population of hospitalized medical patients and identified risk factors at admission associated with in-hospital bleeding. This information may assist physicians in deciding whether to use mechanical or pharmacologic VTE prophylaxis.
| Original language | English |
|---|---|
| Pages (from-to) | 69-79 |
| Number of pages | 11 |
| Journal | Chest |
| Volume | 139 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - Jan 1 2011 |
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ASJC Scopus subject areas
- Pulmonary and Respiratory Medicine
- Critical Care and Intensive Care Medicine
- Cardiology and Cardiovascular Medicine
Cite this
Factors at admission associated with bleeding risk in medical patients : Findings from the improve investigators. / Decousus, Hervé; Tapson, Victor F.; Bergmann, Jean François; Chong, Beng H.; Froehlich, James B.; Kakkar, Ajay K.; Merli, Geno J.; Monreal, Manuel; Nakamura, Mashio; Pavanello, Ricardo; Pini, Mario; Piovella, Franco; Spencer, Frederick A.; Spyropoulos, Alex C.; Turpie, Alexander G G; Zotz, Rainer B.; FitzGerald, Gordon; Anderson, Frederick A.
In: Chest, Vol. 139, No. 1, 01.01.2011, p. 69-79.Research output: Contribution to journal › Article
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TY - JOUR
T1 - Factors at admission associated with bleeding risk in medical patients
T2 - Findings from the improve investigators
AU - Decousus, Hervé
AU - Tapson, Victor F.
AU - Bergmann, Jean François
AU - Chong, Beng H.
AU - Froehlich, James B.
AU - Kakkar, Ajay K.
AU - Merli, Geno J.
AU - Monreal, Manuel
AU - Nakamura, Mashio
AU - Pavanello, Ricardo
AU - Pini, Mario
AU - Piovella, Franco
AU - Spencer, Frederick A.
AU - Spyropoulos, Alex C.
AU - Turpie, Alexander G G
AU - Zotz, Rainer B.
AU - FitzGerald, Gordon
AU - Anderson, Frederick A.
PY - 2011/1/1
Y1 - 2011/1/1
N2 - Background: Acutely ill, hospitalized medical patients are at risk of VTE. Despite guidelines for VTE prevention, prophylaxis use in these patients is still poor, possibly because of fear of bleeding risk. We used data from the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) to assess in-hospital bleeding incidence and to identify risk factors at admission associated with in-hospital bleeding risk in acutely ill medical patients. Methods: IMPROVE is a multinational, observational study that enrolled 15,156 medical patients. The in-hospital bleeding incidence was estimated by Kaplan-Meier analysis. A multiple regression model analysis was performed to identify risk factors at admission associated with bleeding. Results: The cumulative incidence of major and nonmajor in-hospital bleeding within 14 days of admission was 3.2%. Active gastroduodenal ulcer (OR, 4.15; 95% CI, 2.21-7.77), prior bleeding (OR, 3.64; 95% CI, 2.21-5.99), and low platelet count (OR, 3.37; 95% CI, 1.84-6.18) were the strongest independent risk factors at admission for bleeding. Other bleeding risk factors were increased age, hepatic or renal failure, ICU stay, central venous catheter, rheumatic disease, cancer, and male sex. Using these bleeding risk factors, a risk score was developed to estimate bleeding risk. Conclusions: We assessed the incidence of major and clinically relevant bleeding in a large population of hospitalized medical patients and identified risk factors at admission associated with in-hospital bleeding. This information may assist physicians in deciding whether to use mechanical or pharmacologic VTE prophylaxis.
AB - Background: Acutely ill, hospitalized medical patients are at risk of VTE. Despite guidelines for VTE prevention, prophylaxis use in these patients is still poor, possibly because of fear of bleeding risk. We used data from the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) to assess in-hospital bleeding incidence and to identify risk factors at admission associated with in-hospital bleeding risk in acutely ill medical patients. Methods: IMPROVE is a multinational, observational study that enrolled 15,156 medical patients. The in-hospital bleeding incidence was estimated by Kaplan-Meier analysis. A multiple regression model analysis was performed to identify risk factors at admission associated with bleeding. Results: The cumulative incidence of major and nonmajor in-hospital bleeding within 14 days of admission was 3.2%. Active gastroduodenal ulcer (OR, 4.15; 95% CI, 2.21-7.77), prior bleeding (OR, 3.64; 95% CI, 2.21-5.99), and low platelet count (OR, 3.37; 95% CI, 1.84-6.18) were the strongest independent risk factors at admission for bleeding. Other bleeding risk factors were increased age, hepatic or renal failure, ICU stay, central venous catheter, rheumatic disease, cancer, and male sex. Using these bleeding risk factors, a risk score was developed to estimate bleeding risk. Conclusions: We assessed the incidence of major and clinically relevant bleeding in a large population of hospitalized medical patients and identified risk factors at admission associated with in-hospital bleeding. This information may assist physicians in deciding whether to use mechanical or pharmacologic VTE prophylaxis.
UR - http://www.scopus.com/inward/record.url?scp=78651416799&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=78651416799&partnerID=8YFLogxK
U2 - 10.1378/chest.09-3081
DO - 10.1378/chest.09-3081
M3 - Article
C2 - 20453069
AN - SCOPUS:78651416799
VL - 139
SP - 69
EP - 79
JO - Chest
JF - Chest
SN - 0012-3692
IS - 1
ER -