AIMS65 ‘reliable predictor’ of death, rebleeding after factor Xa reversal for GI bleeding
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Key takeaways:
- AIMS65 score predicted mortality and rebleeding for patients on anticoagulants with gastrointestinal bleeding.
- Impaired mental status was strongest AIMS65 risk factor for in-hospital death.
PHILADELPHIA — The AIMS65 risk score may help predict which patients with direct oral anticoagulant-associated gastrointestinal bleeding are at heightened risk for rebleeding and death, according to late-breaking data.
“The AIMS65 is an effective risk score tool for predicting in-hospital mortality and rebleeding exclusively for patients with upper GI bleeding,” Brooks D. Cash, MD, AGAF, FACG, FACP, FASGE, Dan and Lillie Sterling Professor of Medicine and chief of the division of gastroenterology, hepatology and nutrition at University of Texas Health Science Center at Houston, told Healio. “Our objective was to assess the association between the AIMS65 score and the risk of mortality/rebleed in patients with major direct oral anticoagulant (DOAC)-associated GI bleeding, regardless of GI bleeding location.”
He added: “We chose to evaluate this in a group of patients who were hospitalized for DOAC-associated GI bleeding and received anticoagulation reversal therapy, serving as a proxy for major GI bleeding.”
In a retrospective study, Cash and colleagues identified 1,860 medical records from 409 hospitals of adults (median age, 67 years; 63% men) hospitalized for factor Xa inhibitor- associated GI bleeding, either from receiving apixaban or rivaroxaban. Patients were treated with either an andexanet alfa (AA) or 4-factor prothrombin complex concentrate (4F-PCC) for anticoagulation reversal.
The researchers calculated AIMS65 score prior to anticoagulation reversal and also assessed discrimination and relative risk for a score of at least 3.
According to data presented at the ACG Annual Scientific Meeting, 71.8% of patients were on apixaban prior to the GI bleed, with 46% receiving AA and 46% 4F-PCC for anticoagulation reversal. The most common comorbidity was atrial fibrillation (50.3%), followed by hypertension (43.7%) and diabetes (39.5%).
In addition, 19.3% of patients had a history of GI bleeding, 44% with upper GI, 37.8% with lower GI and 18% with multiple or unspecified sources. The mean AIMS65 score was 1.8 and median score was 2, the researchers noted.
When comparing death and rebleeding rates between those with a AIMS65 score of at least 3 and those with a score less than 3, rates were 24.1% vs. 1.6% (OR = 19.4; 95% CI, 12.4-31.7) and 14.4% vs. 2.1% (OR = 7.8; 95% CI, 5-12.4), respectively. This demonstrated that as AIMS65 increased, so did the risk for death and rebleeding, the researchers said.
“AIMS65 remains a reliable predictor for mortality and rebleeding in the context of major DOAC-associated GI bleeding, regardless of the GI bleed location,” Cash told Healio. “However, it is worth noting that the components of the risk scores do not carry equal weight, with some components significantly outperforming others, such as altered mental status.”
According to Cash, 50.8% of patients presented with impaired mental status, making it the “most impactful predictor for in-hospital mortality among all the components of AIMS65.”
“Changes in mental status could indicate reduced or diminished perfusion, suggesting that there might be potential for further research to enhance AIMS65 by incorporating specific or primary predictors of reduced/diminished perfusion status,” he added.
“Given the strong predictability of AIMS65 on in-hospital mortality, this risk score tool should be incorporated into triage assessments within health care settings to identify patients that would require immediate and aggressive management.”
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Cash BD, et al. AIMS65 as an indicator of rebleed and mortality risk in patients using factor Xa inhibitors hospitalized for a gastrointestinal (GI) bleed. Presented at ACG Annual Scientific Meeting; Oct. 25-30, 2024; Philadelphia (hybrid meeting).
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