Factors at admission associated with bleeding risk in medical patients: Findings from the improve investigators

Hervé Decousus, Victor F. Tapson, Jean François Bergmann, Beng H. Chong, James B. Froehlich, Ajay K. Kakkar, Geno J. Merli, Manuel Monreal, Mashio Nakamura, Ricardo Pavanello, Mario Pini, Franco Piovella, Frederick A. Spencer, Alex C. Spyropoulos, Alexander G G Turpie, Rainer B. Zotz, Gordon FitzGerald, Frederick A. Anderson

Research output: Contribution to journalArticle

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 languageEnglish
Pages (from-to)69-79
Number of pages11
JournalChest
Volume139
Issue number1
DOIs
Publication statusPublished - Jan 1 2011

Fingerprint

Research Personnel
Hemorrhage
Incidence
Venous Thromboembolism
Registries
Central Venous Catheters
Liver Failure
Kaplan-Meier Estimate
Rheumatic Diseases
Peptic Ulcer
Platelet Count
Fear
Observational Studies
Renal Insufficiency
Regression Analysis
Guidelines
Physicians

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Decousus, H., Tapson, V. F., Bergmann, J. F., Chong, B. H., Froehlich, J. B., Kakkar, A. K., ... Anderson, F. A. (2011). Factors at admission associated with bleeding risk in medical patients: Findings from the improve investigators. Chest, 139(1), 69-79. https://doi.org/10.1378/chest.09-3081

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 journalArticle

Decousus, H, Tapson, VF, Bergmann, JF, Chong, BH, Froehlich, JB, Kakkar, AK, Merli, GJ, Monreal, M, Nakamura, M, Pavanello, R, Pini, M, Piovella, F, Spencer, FA, Spyropoulos, AC, Turpie, AGG, Zotz, RB, FitzGerald, G & Anderson, FA 2011, 'Factors at admission associated with bleeding risk in medical patients: Findings from the improve investigators', Chest, vol. 139, no. 1, pp. 69-79. https://doi.org/10.1378/chest.09-3081
Decousus H, Tapson VF, Bergmann JF, Chong BH, Froehlich JB, Kakkar AK et al. Factors at admission associated with bleeding risk in medical patients: Findings from the improve investigators. Chest. 2011 Jan 1;139(1):69-79. https://doi.org/10.1378/chest.09-3081
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. / Factors at admission associated with bleeding risk in medical patients : Findings from the improve investigators. In: Chest. 2011 ; Vol. 139, No. 1. pp. 69-79.
@article{8f8063178cac4a4cabace99e6683f97b,
title = "Factors at admission associated with bleeding risk in medical patients: Findings from the improve investigators",
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.",
author = "Herv{\'e} Decousus and Tapson, {Victor F.} and Bergmann, {Jean Fran{\cc}ois} and Chong, {Beng H.} and Froehlich, {James B.} and Kakkar, {Ajay K.} and Merli, {Geno J.} and Manuel Monreal and Mashio Nakamura and Ricardo Pavanello and Mario Pini and Franco Piovella and Spencer, {Frederick A.} and Spyropoulos, {Alex C.} and Turpie, {Alexander G G} and Zotz, {Rainer B.} and Gordon FitzGerald and Anderson, {Frederick A.}",
year = "2011",
month = "1",
day = "1",
doi = "10.1378/chest.09-3081",
language = "English",
volume = "139",
pages = "69--79",
journal = "Chest",
issn = "0012-3692",
publisher = "Elsevier Inc.",
number = "1",

}

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 -