Novel risk score predicts early bleeding in acute PE

The Pulmonary Embolism Syncope-Anemia-Renal Dysfunction risk score was successful in estimating risk for early major bleeding in patients with acute pulmonary embolism, according to new research published in Chest.

“Improved prediction of the major bleeding risk in acute PE is needed to guide management. Several bleeding risk scores have been developed to assess bleeding risk in stable PE patients receiving long-term anticoagulation,” Romain Chopard, MD, PhD, from the department of cardiology at the University Hospital Jean Minjoz, Besançon, France, and colleagues wrote.

Researchers analyzed a multicenter prospective registry and identified three factors associated with early major bleeding in patients with acute PE and created the Pulmonary Embolism Syncope-Anemia-Renal Dysfunction (PE-SARD) bleeding score. Then, the researchers internally validated the risk score and compared its performance with other risk scores, including Venous Thrombo-Embolism Bleed (VTE-BLEED); RIETE (Computerized Registry of Patients with VTE) and Bleeding, Age, Cancer and Syncope (BACS).

Eighty-two patients had a major bleeding event during their in-hospital stay for acute PE. Median time to the bleeding event was 2 days.

The PE-SARD bleeding score was calculated based on three predictors of major bleeding events identified in multivariable regression models: syncope; anemia, defined as hemoglobin less than 12 g/dL; and renal dysfunction, defined as glomerular filtration rate less than 60 mL/min.

Using the novel risk score, 52.2% of patients were classified as low bleeding risk, 35.2% were classified as intermediate bleeding risk and 12.6% were classified as high bleeding risk.

Bleeding rates were greater with increasing risk group: 0.97% in the low bleeding risk group and 8.93% in the high bleeding risk group. The researchers reported the C-index was 0.74 and Brier score was 0.028.

The PE-SARD bleeding score had improved performance compared with that with the VTE-BLEED, RIETE and BACS models, according to the results. Use of the PE-SARD risk score also led to a higher proportion of bleeding risk reclassification: 72.4% in the low bleeding risk group, 58% in the intermediate bleeding risk group and 72.4% in the high bleeding risk group.

“Further studies are required to externally validate our score and to determine its clinical usefulness for acute PE patient management,” the researchers wrote.