Abstract
Severe perioperative bleeding after coronary artery bypass grafting (CABG) is associated with poor outcome. An additive score for prediction of severe bleeding was derived (n=2494) and validated (n=1250) in patients from the E-CABG registry. Severe bleeding was defined as E-CABG bleeding grades 2-3 (transfusion of >4 units of red blood cells or reoperation for bleeding). The overall incidence of severe bleeding was 6.4 %. Preoperative anaemia (3 points), female gender (2 points), eGFR <45 ml/min/1.73 m2 (3 points), potent antiplatelet drugs discontinued less than five days (2 points), critical preoperative state (5 points), acute coronary syndrome (2 points), use of low-molecular-weight heparin/fondaparinux/unfractionated heparin (1 point) were independent predictors of severe bleeding. The WILL-BLEED score was associated with increasing rates of severe bleeding in both the derivation and validation cohorts (scores 0-3: 2.9 % vs 3.4 %; scores 4-6: 6.8 % vs 7.5 %; scores>6: 24.6 % vs 24.2 %, both p<0.0001). The WILL-BLEED score had a better discriminatory ability (AUC 0.725) for prediction of severe bleeding compared to the ACTION (AUC 0.671), CRUSADE (AUC 0.642), Papworth (AUC 0.605), TRUST (AUC 0.660) and TRACK (AUC 0.640) bleeding scores. The net reclassification index and integrated discrimination improvement using the WILL-BLEED score as opposed to the other bleeding scores were significant (p<0.0001). The decision curve analysis demonstrated a net benefit with the WILL-BLEED score compared to the other bleeding scores. In conclusion, the WILL-BLEED risk score is a simple risk stratification method which allows the identification of patients at high risk of severe bleeding after CABG.
| Original language | English |
|---|---|
| Pages (from-to) | 445-456 |
| Number of pages | 12 |
| Journal | Thrombosis and Haemostasis |
| Volume | 117 |
| Issue number | 3 |
| DOIs | |
| Publication status | Published - Jan 1 2017 |
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Keywords
- Bleeding
- CABG
- Cardiac surgery
- Coronary artery bypass grafting
- Risk Score
ASJC Scopus subject areas
- Hematology
Cite this
Prediction of severe bleeding after coronary surgery : The will-bleed risk score. / Biancari, Fausto; Brascia, Debora; Onorati, Francesco; Reichart, Daniel; Perrotti, Andrea; Ruggieri, Vito G.; Santarpino, Giuseppe; Maselli, Daniele; Mariscalco, Giovanni; Gherli, Riccardo; Rubino, Antonino S.; De Feo, Marisa; Gatti, Giuseppe; Santini, Francesco; Dalén, Magnus; Saccocci, Matteo; Kinnunen, Eeva Maija; Airaksinen, Juhani K.E.; D’Errigo, Paola; Rosato, Stefano; Nicolini, Francesco.
In: Thrombosis and Haemostasis, Vol. 117, No. 3, 01.01.2017, p. 445-456.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Prediction of severe bleeding after coronary surgery
T2 - The will-bleed risk score
AU - Biancari, Fausto
AU - Brascia, Debora
AU - Onorati, Francesco
AU - Reichart, Daniel
AU - Perrotti, Andrea
AU - Ruggieri, Vito G.
AU - Santarpino, Giuseppe
AU - Maselli, Daniele
AU - Mariscalco, Giovanni
AU - Gherli, Riccardo
AU - Rubino, Antonino S.
AU - De Feo, Marisa
AU - Gatti, Giuseppe
AU - Santini, Francesco
AU - Dalén, Magnus
AU - Saccocci, Matteo
AU - Kinnunen, Eeva Maija
AU - Airaksinen, Juhani K.E.
AU - D’Errigo, Paola
AU - Rosato, Stefano
AU - Nicolini, Francesco
PY - 2017/1/1
Y1 - 2017/1/1
N2 - Severe perioperative bleeding after coronary artery bypass grafting (CABG) is associated with poor outcome. An additive score for prediction of severe bleeding was derived (n=2494) and validated (n=1250) in patients from the E-CABG registry. Severe bleeding was defined as E-CABG bleeding grades 2-3 (transfusion of >4 units of red blood cells or reoperation for bleeding). The overall incidence of severe bleeding was 6.4 %. Preoperative anaemia (3 points), female gender (2 points), eGFR <45 ml/min/1.73 m2 (3 points), potent antiplatelet drugs discontinued less than five days (2 points), critical preoperative state (5 points), acute coronary syndrome (2 points), use of low-molecular-weight heparin/fondaparinux/unfractionated heparin (1 point) were independent predictors of severe bleeding. The WILL-BLEED score was associated with increasing rates of severe bleeding in both the derivation and validation cohorts (scores 0-3: 2.9 % vs 3.4 %; scores 4-6: 6.8 % vs 7.5 %; scores>6: 24.6 % vs 24.2 %, both p<0.0001). The WILL-BLEED score had a better discriminatory ability (AUC 0.725) for prediction of severe bleeding compared to the ACTION (AUC 0.671), CRUSADE (AUC 0.642), Papworth (AUC 0.605), TRUST (AUC 0.660) and TRACK (AUC 0.640) bleeding scores. The net reclassification index and integrated discrimination improvement using the WILL-BLEED score as opposed to the other bleeding scores were significant (p<0.0001). The decision curve analysis demonstrated a net benefit with the WILL-BLEED score compared to the other bleeding scores. In conclusion, the WILL-BLEED risk score is a simple risk stratification method which allows the identification of patients at high risk of severe bleeding after CABG.
AB - Severe perioperative bleeding after coronary artery bypass grafting (CABG) is associated with poor outcome. An additive score for prediction of severe bleeding was derived (n=2494) and validated (n=1250) in patients from the E-CABG registry. Severe bleeding was defined as E-CABG bleeding grades 2-3 (transfusion of >4 units of red blood cells or reoperation for bleeding). The overall incidence of severe bleeding was 6.4 %. Preoperative anaemia (3 points), female gender (2 points), eGFR <45 ml/min/1.73 m2 (3 points), potent antiplatelet drugs discontinued less than five days (2 points), critical preoperative state (5 points), acute coronary syndrome (2 points), use of low-molecular-weight heparin/fondaparinux/unfractionated heparin (1 point) were independent predictors of severe bleeding. The WILL-BLEED score was associated with increasing rates of severe bleeding in both the derivation and validation cohorts (scores 0-3: 2.9 % vs 3.4 %; scores 4-6: 6.8 % vs 7.5 %; scores>6: 24.6 % vs 24.2 %, both p<0.0001). The WILL-BLEED score had a better discriminatory ability (AUC 0.725) for prediction of severe bleeding compared to the ACTION (AUC 0.671), CRUSADE (AUC 0.642), Papworth (AUC 0.605), TRUST (AUC 0.660) and TRACK (AUC 0.640) bleeding scores. The net reclassification index and integrated discrimination improvement using the WILL-BLEED score as opposed to the other bleeding scores were significant (p<0.0001). The decision curve analysis demonstrated a net benefit with the WILL-BLEED score compared to the other bleeding scores. In conclusion, the WILL-BLEED risk score is a simple risk stratification method which allows the identification of patients at high risk of severe bleeding after CABG.
KW - Bleeding
KW - CABG
KW - Cardiac surgery
KW - Coronary artery bypass grafting
KW - Risk Score
UR - http://www.scopus.com/inward/record.url?scp=85014334317&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85014334317&partnerID=8YFLogxK
U2 - 10.1160/TH16-09-0721
DO - 10.1160/TH16-09-0721
M3 - Article
C2 - 27904903
AN - SCOPUS:85014334317
VL - 117
SP - 445
EP - 456
JO - Thrombosis and Haemostasis
JF - Thrombosis and Haemostasis
SN - 0340-6245
IS - 3
ER -