Performance of Bleeding Risk Scores for Major Bleeding in Anticoagulated Patients with Pulmonary Embolism: Insights from the CURES Registry-2

Most bleeding risk scores for pulmonary embolism (PE) were developed in patients receiving traditional anticoagulants. Evidence in East Asian populations and its applicability to direct oral anticoagulants (DOACs) remain limited.This post-hoc analysis was based on a multicentre, prospective study (NCT02943343) conducted from 2016 to 2021. The predictive performance of bleeding risk scores was assessed using a time-dependent area under the receiver operating characteristic curve (AUC), net reclassification improvement (NRI), and decision curve analysis (DCA). Propensity score matching (PSM) was adjusted for baseline characteristics. We analyzed the impact of initial DOAC versus low-molecular-weight heparin (LMWH) on outcomes. The endpoint was major bleeding (MB) within 90 days and composite outcomes (all-cause mortality, recurrent VTE, and MB).Of 7,619 patients with PE, 1.4% (107 patients) experienced MB within 90 days. The RIETE score showed a modest predictive ability (AUC: 0.70; 95% CI, 0.65-0.75) for predicting 90-day MB and demonstrated a predictive advantage in the DCA results. NRI also revealed significantly better reclassification capability than the other scores, except for HAS-BLED. Among low-risk patients classified by the RIETE score, initial DOAC treatment significantly reduced 14-day composite outcomes compared with LMWH (HR = 0.13; 95% CI, 0.02-0.93). Furthermore, DOACs at discharge did not increase the risk of MB or composite outcomes.RIETE score shows modest performance in predicting MB and identifying low bleeding risk in PE patients, which could potentially guide early DOAC use. Further studies are needed to test its clinical utility, especially in East Asian populations.

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Publication Details

Journal
Thrombosis and Haemostasis
Published
2025-06-24
DOI
https://doi.org/10.1055/a-2642-0241
Citations
3
Primary Topic
Venous Thromboembolism Diagnosis and Management
Type
article
Field-Weighted Citation Impact
5.61

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article

Performance of Bleeding Risk Scores for Major Bleeding in Anticoagulated Patients with Pulmonary Embolism: Insights from the CURES Registry-2

P. Lu, Qian Gao, Yi-Wei Shi, Yongjun Tang et al.
3 citations
Thrombosis and Haemostasis
Venous Thromboembolism Diagnosis and Management
5.61
article

Performance of Bleeding Risk Scores for Major Bleeding in Anticoagulated Patients with Pulmonary Embolism: Insights from the CURES Registry-2

P. Lu, Qian Gao, Yi-Wei Shi, Yongjun Tang, Juhong Shi, Chunling Dong, Qin Luo, Ling Zhu, Yuanhua Yang, Maoyun Wang, Yingqun Ji, Chen Wang, Peiran B Yang, Zhe Cheng, Qiang Huang, Guohui Fan, Shengfeng Wang, Shuai Zhang, Min Liu, Zhu Zhang, Hong Chen, Hong Chen, Yu Zhang, Jie Zhang, Dingyi Wang, Yanxia Li, Yuzhi Tao, Jun Wan, Chaosheng Deng, Wanmu Xie, Yunxia Zhang, Xiaomao Xu, Rui Liang
article en
3 citations

Abstract

Most bleeding risk scores for pulmonary embolism (PE) were developed in patients receiving traditional anticoagulants. Evidence in East Asian populations and its applicability to direct oral anticoagulants (DOACs) remain limited.This post-hoc analysis was based on a multicentre, prospective study (NCT02943343) conducted from 2016 to 2021. The predictive performance of bleeding risk scores was assessed using a time-dependent area under the receiver operating characteristic curve (AUC), net reclassification improvement (NRI), and decision curve analysis (DCA). Propensity score matching (PSM) was adjusted for baseline characteristics. We analyzed the impact of initial DOAC versus low-molecular-weight heparin (LMWH) on outcomes. The endpoint was major bleeding (MB) within 90 days and composite outcomes (all-cause mortality, recurrent VTE, and MB).Of 7,619 patients with PE, 1.4% (107 patients) experienced MB within 90 days. The RIETE score showed a modest predictive ability (AUC: 0.70; 95% CI, 0.65-0.75) for predicting 90-day MB and demonstrated a predictive advantage in the DCA results. NRI also revealed significantly better reclassification capability than the other scores, except for HAS-BLED. Among low-risk patients classified by the RIETE score, initial DOAC treatment significantly reduced 14-day composite outcomes compared with LMWH (HR = 0.13; 95% CI, 0.02-0.93). Furthermore, DOACs at discharge did not increase the risk of MB or composite outcomes.RIETE score shows modest performance in predicting MB and identifying low bleeding risk in PE patients, which could potentially guide early DOAC use. Further studies are needed to test its clinical utility, especially in East Asian populations.

Thrombosis and Haemostasis
Fujian Medical University (CN), Central South University (CN), Xinjiang Medical University (CN), Harbin Medical University (CN), Shanxi Medical University (CN), Beijing University of Chinese Medicine (CN), Capital Medical University (CN), Dalian Medical University (CN), Chengde Medical University (CN), Jilin University (CN), Chinese Academy of Medical Sciences & Peking Union Medical College (CN), Peking University (CN), Sichuan University (CN), Beijing Chao-Yang Hospital, Capital Medical University (CN), China-Japan Friendship Hospital (CN), Peking Union Medical College Hospital (CN), National Clinical Research Center for Digestive Diseases (CN), West China Hospital of Sichuan University (CN), Tumor Hospital of Xinjiang Medical University (CN), Chengde Medical University (CN), Shandong Provincial Hospital (CN), Beijing Anzhen Hospital (CN), Beijing Hospital (CN), First Affiliated Hospital of Fujian Medical University (CN), First Hospital of Jilin University (CN), First Hospital of Shanxi Medical University (CN), Shanghai East Hospital (CN), The Affiliated Yongchuan Hospital of Chongqing Medical University (CN), Second Affiliated Hospital of Harbin Medical University (CN), First Affiliated Hospital of Dalian Medical University (CN), Second Affiliated Hospital of Jilin University (CN), First Bethune Hospital of Jilin University (CN), First Affiliated Hospital of Zhengzhou University (CN), Xiangya Hospital Central South University (CN), Shandong First Medical University (CN), Beijing Chaoyang Emergency Medical Center (CN), Chongqing Medical University (CN)
National Natural Science Foundation of China, Ministry of Science and Technology of the People's Republic of China
Good health and well-being
Openalex Percentile: Top 4%
Venous Thromboembolism Diagnosis and Management
5.61
DOIOpen Access PDFOpenAlex
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