Factors at Admission Associated With Bleeding Risk in Medical Patients

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

doi:10.1378/chest.09-3081

Cited by 374 publications

(350 citation statements)

References 34 publications

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“…Accordingly, our study and Decousus et al (2011), reached to the same conclusion which is, the benefit of utilizing the IMPROVE score helps to prevent major and non-major but clinically significant bleeding incidences [10]. Nevertheless, one of the major drawbacks of the IMPROVE bleeding risk calculator is the absence of a score assigned to medications with the potential to cause or increase the risk of bleeding.…”

Section: Discussionsupporting

confidence: 57%

“…In our study, 57 patients (71.25%) patients had a Padua score of ≥4, which validate the use of VTE prophylaxis measure. However, 13 patients (22.8%) out of the 57 had a high risk of bleeding according to the IMPROVE score (≥7) [10]. Hence, as per the CHEST guidelines, patients with high bleeding risk should have been placed on a mechanical prophylaxis methods [6].…”

Section: Discussionmentioning

confidence: 99%

“…Yet, if VTE risk is high, and clinical judgments favor the use of a pharmacological agent, these agents should be used with caution and alerts should appear in the CPOE. Decousus et al (2011), conducted an observational study using data from the IMPROVE trial to assess the in-hospital bleeding incidence, and identify the risk factors for bleeding in acutely ill medical patients [10]. The study revealed that the bleeding risk begins to increase exponentially in patients with IMPROVE score ≥7 [10].…”

Section: Discussionmentioning

confidence: 99%

“…To determine which option to choose for VTE prophylaxis the bleeding risk need to be investigated as well. The IMPROVE bleeding risk assessment score was used to evaluate the risk of bleeding and provide directions on whether to choose mechanical or pharmacological prophylactic measure [10]. A bleeding score of ≥7 indicates a high risk of bleeding and in this case VTE prophylaxis is preferred to be mechanical [6].…”

Section: Guidelines and Scoring Systemsmentioning

confidence: 99%

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The Use of Low Molecular Weight Heparin for Venous Thromboembolism Prophylaxis in Medical Patients: How Much Are We Adherent to the Guidelines?

AlHajri¹,

Gebran²

2015

OJIM

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Background: Venous thromboembolism (VTE) is a common complication seen during or after hospitalization that manifests as deep venous thrombosis (DVT) and/or pulmonary embolism (PE). PE is considered the commonest preventable cause of death during and/or after hospitalization. Thus, pharmacological and mechanical methods are used to prevent VTE in hospitalized patients. Despite the availability of guidelines for VTE prophylaxis, it is crucial to assess the adherence and adaptation of the institution to these guidelines. Purpose: This study aimed to investigate adherence to the American College of Chest Physicians (ACCP) 2012 VTE prophylaxis guidelines in hospitalized medical patients in a tertiary care hospital in the United Arab Emirates. Methods: An observational prospective design was utilized in this study. To achieve the purpose, primary and secondary end points were identified to be the core of the investigation. The primary end points were: the incidence of bleeding, VTE, and cardiovascular events. While the secondary end points were: dose and indication validity for prophylaxis, VTE and bleeding risk assessments, adverse drug events (ADE) other than bleeding, appropriate monitoring when on low molecular weight heparin (LMWH) and the presence of contraindication at the time of prescribing LMWH. Results: 16 patients (20%) out of the total 80 met one or more of the primary end points. The vast majority of patients (81.25%) developed bleeding, while VTE was seen in one case only during hospitalization. 11 patients (13.75%) received LMWH while a contraindication was present. 15 patients (18.75%) who were prescribed LMWH had an International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) bleeding risk score of ≥7. However, 5 out of 13 patients (38.46%) who developed bleeding had a bleeding score of ≥7, and the relationship between bleeding score of ≥7 and the development of bleeding was statistically significant (p = 0.047). When investigating the doses that were utilized, 40% were prescribed an inappropriate dose. L. AlHajri, N. Gebran 82Conclusion: Various factors played a role in the inappropriateness of VTE prophylaxis such as; poor adherence to VTE guidelines, inappropriate dosing and monitoring, and not evaluating the bleeding risk. Hence, to be able to achieve effective VTE prophylaxis, these factors need to be addressed through adherence to and adaptation of the ACCP 2012 VTE prophylaxis guidelines.

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Section: Discussionsupporting

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Guidelines and Scoring Systemsmentioning

confidence: 99%

See 2 more Smart Citations

The Use of Low Molecular Weight Heparin for Venous Thromboembolism Prophylaxis in Medical Patients: How Much Are We Adherent to the Guidelines?

AlHajri¹,

Gebran²

2015

OJIM

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“…Specific patient characteristics that are associated with an increased bleeding risk during anticoagulant therapy are renal failure, a history of bleeding and a simultaneous intake of platelet aggregation inhibitors (Decousus et al 2011;Falck-Ytter et al 2012). The level of risk doubles in older patients (≥ 65 years) compared to younger patients (Spencer et al 2008).…”

Section: K Bleeding Risk In Patients On Anticoagulant Therapymentioning

confidence: 99%

Status of Healthcare

Weißer¹,

Zerwes²,

Krupka

et al. 2018

White Paper on Joint Replacement

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Cardiovascular Events and Bleeding Risk Associated With Intravitreal Antivascular Endothelial Growth Factor Monoclonal Antibodies

et al. 2014

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IMPORTANCE Few data exist regarding the systemic safety of intravitreal antivascular endothelial growth factor (anti-VEGF) monoclonal antibody (mAb).OBJECTIVE To conduct a systematic review and meta-analysis to evaluate the risk of major cardiovascular and nonocular hemorrhagic events in patients with neovascular age-related macular degeneration (AMD), diabetes mellitus-associated macular edema (DME), or retinal vein occlusions (RVOs) who receive intravitreal anti-VEGF mAbs.DATA SOURCES The MEDLINE and Cochrane Central databases were searched for potentially eligible studies.STUDY SELECTION Randomized clinical trials comparing ranibizumab or bevacizumab with no anti-VEGF treatment, as well as those comparing ranibizumab with bevacizumab in patients with AMD, DME, or RVOs. DATA EXTRACTION AND SYNTHESISWe used a fixed-effects model and report the results as odds ratios (ORs) and 95% CIs. MAIN OUTCOMES AND MEASURESPrimary end points were major cardiovascular and nonocular hemorrhagic events. Secondary end points were all-cause mortality, cardiovascular mortality, stroke, myocardial infarction, venous thromboembolic events (VTEs), and hypertension.RESULTS Twenty-one trials that evaluated 9557 patients were retrieved. Anti-VEGF mAbs did not significantly increase the risk of major cardiovascular events (OR, 1.18; 95% CI, 0.81-1.71) or nonocular hemorrhagic events (OR, 1.42; 95% CI, 0.95-2.13) in treatment groups compared with control populations. Bevacizumab did not increase the risk of major cardiovascular events (OR, 0.94; 95% CI, 0.59-1.52) or nonocular hemorrhagic events (OR, 2.56; 95% CI, 0.78-8.38) compared with ranibizumab, but significantly increased VTEs (OR, 3.45; 95% CI, 1.25-9.54). Subgroup analysis showed a significant increase of nonocular hemorrhagic events in patients with AMD in ranibizumab vs control trials (OR, 1.57; 95% CI, 1.01-2.44). Anti-VEGF mAbs did not significantly increase overall mortality, cardiovascular mortality, stroke, myocardial infarction, VTEs, or hypertension. CONCLUSIONS AND RELEVANCEWe showed that intravitreal anti-VEGF-mAbs were not associated with significant increases in major cardiovascular or nonocular hemorrhagic events, but studies and meta-analyses were not powered enough to correctly assess these risks. Increased risks of VTEs with bevacizumab and nonocular hemorrhagic events in older patients with AMD with ranibizumab should be cautiously interpreted because more safety data are needed.

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Factors at Admission Associated With Bleeding Risk in Medical Patients

Cited by 374 publications

References 34 publications

The Use of Low Molecular Weight Heparin for Venous Thromboembolism Prophylaxis in Medical Patients: How Much Are We Adherent to the Guidelines?

The Use of Low Molecular Weight Heparin for Venous Thromboembolism Prophylaxis in Medical Patients: How Much Are We Adherent to the Guidelines?

Status of Healthcare

Cardiovascular Events and Bleeding Risk Associated With Intravitreal Antivascular Endothelial Growth Factor Monoclonal Antibodies

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