Factors at admission associated with bleeding risk in medical patients: findings from the IMPROVE investigators
Center for Outcomes Research
Acute Disease; Aged; Female; Fibrinolytic Agents; Hemorrhage; Humans; Incidence; *Inpatients; Length of Stay; Male; Middle Aged; Patient Admission; Prognosis; Retrospective Studies; Risk Assessment; Risk Factors; Survival Rate; Thromboembolism
Cardiovascular Diseases | Health Services Research
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.
DOI of Published Version
Chest. 2011 Jan;139(1):69-79. Epub 2010 May 7. Link to article on publisher's site
Decousus H, Tapson VF, Bergmann J, Chong BH, Froehlich JB, Kakkar AK, Merli GJ, Monreal M, Nakamura M, Pavanello R, Pini M, Piovella F, Spencer FA, Spyropoulos AC, Turpie AG, Zotz RB, Fitzgerald G, Anderson FA, IMPROVE Investigators. (2011). Factors at admission associated with bleeding risk in medical patients: findings from the IMPROVE investigators. IMPROVE Publications. https://doi.org/10.1378/chest.09-3081. Retrieved from https://escholarship.umassmed.edu/cor_improve/1