Clinical characteristics, time course, and outcomes of major bleeding according to bleeding site in patients with venous thromboembolism

Background: Bleeding is the most dreaded complication of anticoagulant therapy for acute venous thromboembolism (VTE). Limited data exist about patient characteristics, time course and outcomes of major bleeding, according to the bleeding site. Methods: We used the data from the Registro Informatiza...

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Autores: Bikdeli, Behnood, Moustafa, Fares, Nieto, José Antonio, Lee, Alfred I., Ruiz-Giménez Arrieta, Nuria, Lorenzo, Alicia, Schellong, Sebastian, Soler, Silvia, Ortiz Serrano, Salvador, Morales, María del Valle, Bosevski, Marijan, Gavín, Olga, Lip, Gregory Y.H., Monreal, Manuel
Tipo de recurso: artículo
Fecha de publicación:2022
País:España
Institución:Universidad Autónoma de Madrid
Repositorio:Biblos-e Archivo. Repositorio Institucional de la UAM
Idioma:inglés
OAI Identifier:oai:repositorio.uam.es:10486/725940
Acceso en línea:https://hdl.handle.net/10486/725940
https://dx.doi.org/10.1016/j.thromres.2022.01.007
Access Level:acceso abierto
Palabra clave:Bleeding
Venous thromboembolism
Site
Intracranial
Retroperitoneal
Outcomes
Medicina
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spelling Clinical characteristics, time course, and outcomes of major bleeding according to bleeding site in patients with venous thromboembolismBikdeli, BehnoodMoustafa, FaresNieto, José AntonioLee, Alfred I.Ruiz-Giménez Arrieta, NuriaLorenzo, AliciaSchellong, SebastianSoler, SilviaOrtiz Serrano, SalvadorMorales, María del ValleBosevski, MarijanGavín, OlgaLip, Gregory Y.H.Monreal, ManuelBleedingVenous thromboembolismSiteIntracranialRetroperitonealOutcomesMedicinaBackground: Bleeding is the most dreaded complication of anticoagulant therapy for acute venous thromboembolism (VTE). Limited data exist about patient characteristics, time course and outcomes of major bleeding, according to the bleeding site. Methods: We used the data from the Registro Informatizado Enfermedad TromboEmbólica (RIETE) registry (03/ 2001–07/2018) and identified patients who suffered from major bleeding during anticoagulation. We assessed patient characteristics, time course, and 30-day outcomes including mortality, re-bleeding, and VTE recurrences, according to bleeding site. Results: Among 78,136 patients with VTE receiving anticoagulation, 2244 (2.9%) suffered from major bleeding (gastrointestinal in 800, intracranial in 417, hematoma in 410, genitourinary in 222, retroperitoneal in 145; other sites in 250). There were variations in baseline characteristics, including older age (P <0.001) and predominance of women (70.2% [95% confidence interval [CI]]: 65.6–74.6% versus 50.5%, 95% CI: 48.2–52.9, P < 0.001) in patients with hematoma, compared with other patients. Overall, 82.7% of hematomas and 81.4% of retroperitoneal bleeds occurred in the first 90 days after the diagnosis of the VTE event, compared with only 50.6% of intracranial bleeds. Across the bleeding subgroups, 30-day all-cause mortality rates were highest in patients who suffered from intracranial bleeding (41.0%; 99% confidence interval [CI]: 34.8–47.4%), and lowest in patients who suffered from hematoma (17.8%; 99% CI: 13.2–23.2%). Patients who suffered from a major bleeding event in the first 30 days after VTE had significantly higher odds at 90-day follow-up to develop mortality (including from bleeding), recurrent VTE, and recurrent major bleeding (all Ps < 0.001). Variations were observed in the results according to the bleeding site. Conclusions: Major bleeding is a serious complication in VTE patients. Patient characteristics, time course and outcomes varied substantially according to the bleeding site. Additional studies are needed to tease out the impact of patient risk factors, treatment regimens, and a potential distinct effect from the site of bleeding. Trial registration: https://clinicaltrials.gov/ct2/show/NCT02832245 (RIETE registry)ElsevierDepartamento de Economía AplicadaFacultad de Ciencias Económicas y Empresariales20222022-01-14research articlehttp://purl.org/coar/resource_type/c_2df8fbb1VoRhttp://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/articleapplication/pdfhttps://hdl.handle.net/10486/725940https://dx.doi.org/10.1016/j.thromres.2022.01.007reponame:Biblos-e Archivo. Repositorio Institucional de la UAMinstname:Universidad Autónoma de MadridInglésengopen accesshttp://purl.org/coar/access_right/c_abf2Attribution-NonCommercial-NoDerivatives 4.0 Internationalhttp://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccessoai:repositorio.uam.es:10486/7259402026-06-23T12:46:27Z
dc.title.none.fl_str_mv Clinical characteristics, time course, and outcomes of major bleeding according to bleeding site in patients with venous thromboembolism
title Clinical characteristics, time course, and outcomes of major bleeding according to bleeding site in patients with venous thromboembolism
spellingShingle Clinical characteristics, time course, and outcomes of major bleeding according to bleeding site in patients with venous thromboembolism
Bikdeli, Behnood
Bleeding
Venous thromboembolism
Site
Intracranial
Retroperitoneal
Outcomes
Medicina
title_short Clinical characteristics, time course, and outcomes of major bleeding according to bleeding site in patients with venous thromboembolism
title_full Clinical characteristics, time course, and outcomes of major bleeding according to bleeding site in patients with venous thromboembolism
title_fullStr Clinical characteristics, time course, and outcomes of major bleeding according to bleeding site in patients with venous thromboembolism
title_full_unstemmed Clinical characteristics, time course, and outcomes of major bleeding according to bleeding site in patients with venous thromboembolism
title_sort Clinical characteristics, time course, and outcomes of major bleeding according to bleeding site in patients with venous thromboembolism
dc.creator.none.fl_str_mv Bikdeli, Behnood
Moustafa, Fares
Nieto, José Antonio
Lee, Alfred I.
Ruiz-Giménez Arrieta, Nuria
Lorenzo, Alicia
Schellong, Sebastian
Soler, Silvia
Ortiz Serrano, Salvador
Morales, María del Valle
Bosevski, Marijan
Gavín, Olga
Lip, Gregory Y.H.
Monreal, Manuel
author Bikdeli, Behnood
author_facet Bikdeli, Behnood
Moustafa, Fares
Nieto, José Antonio
Lee, Alfred I.
Ruiz-Giménez Arrieta, Nuria
Lorenzo, Alicia
Schellong, Sebastian
Soler, Silvia
Ortiz Serrano, Salvador
Morales, María del Valle
Bosevski, Marijan
Gavín, Olga
Lip, Gregory Y.H.
Monreal, Manuel
author_role author
author2 Moustafa, Fares
Nieto, José Antonio
Lee, Alfred I.
Ruiz-Giménez Arrieta, Nuria
Lorenzo, Alicia
Schellong, Sebastian
Soler, Silvia
Ortiz Serrano, Salvador
Morales, María del Valle
Bosevski, Marijan
Gavín, Olga
Lip, Gregory Y.H.
Monreal, Manuel
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv Departamento de Economía Aplicada
Facultad de Ciencias Económicas y Empresariales
dc.subject.none.fl_str_mv Bleeding
Venous thromboembolism
Site
Intracranial
Retroperitoneal
Outcomes
Medicina
topic Bleeding
Venous thromboembolism
Site
Intracranial
Retroperitoneal
Outcomes
Medicina
description Background: Bleeding is the most dreaded complication of anticoagulant therapy for acute venous thromboembolism (VTE). Limited data exist about patient characteristics, time course and outcomes of major bleeding, according to the bleeding site. Methods: We used the data from the Registro Informatizado Enfermedad TromboEmbólica (RIETE) registry (03/ 2001–07/2018) and identified patients who suffered from major bleeding during anticoagulation. We assessed patient characteristics, time course, and 30-day outcomes including mortality, re-bleeding, and VTE recurrences, according to bleeding site. Results: Among 78,136 patients with VTE receiving anticoagulation, 2244 (2.9%) suffered from major bleeding (gastrointestinal in 800, intracranial in 417, hematoma in 410, genitourinary in 222, retroperitoneal in 145; other sites in 250). There were variations in baseline characteristics, including older age (P <0.001) and predominance of women (70.2% [95% confidence interval [CI]]: 65.6–74.6% versus 50.5%, 95% CI: 48.2–52.9, P < 0.001) in patients with hematoma, compared with other patients. Overall, 82.7% of hematomas and 81.4% of retroperitoneal bleeds occurred in the first 90 days after the diagnosis of the VTE event, compared with only 50.6% of intracranial bleeds. Across the bleeding subgroups, 30-day all-cause mortality rates were highest in patients who suffered from intracranial bleeding (41.0%; 99% confidence interval [CI]: 34.8–47.4%), and lowest in patients who suffered from hematoma (17.8%; 99% CI: 13.2–23.2%). Patients who suffered from a major bleeding event in the first 30 days after VTE had significantly higher odds at 90-day follow-up to develop mortality (including from bleeding), recurrent VTE, and recurrent major bleeding (all Ps < 0.001). Variations were observed in the results according to the bleeding site. Conclusions: Major bleeding is a serious complication in VTE patients. Patient characteristics, time course and outcomes varied substantially according to the bleeding site. Additional studies are needed to tease out the impact of patient risk factors, treatment regimens, and a potential distinct effect from the site of bleeding. Trial registration: https://clinicaltrials.gov/ct2/show/NCT02832245 (RIETE registry)
publishDate 2022
dc.date.none.fl_str_mv 2022
2022-01-14
dc.type.none.fl_str_mv research article
http://purl.org/coar/resource_type/c_2df8fbb1
VoR
http://purl.org/coar/version/c_970fb48d4fbd8a85
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv https://hdl.handle.net/10486/725940
https://dx.doi.org/10.1016/j.thromres.2022.01.007
url https://hdl.handle.net/10486/725940
https://dx.doi.org/10.1016/j.thromres.2022.01.007
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
Attribution-NonCommercial-NoDerivatives 4.0 International
http://creativecommons.org/licenses/by-nc-nd/4.0/
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
http://purl.org/coar/access_right/c_abf2
Attribution-NonCommercial-NoDerivatives 4.0 International
http://creativecommons.org/licenses/by-nc-nd/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Elsevier
publisher.none.fl_str_mv Elsevier
dc.source.none.fl_str_mv reponame:Biblos-e Archivo. Repositorio Institucional de la UAM
instname:Universidad Autónoma de Madrid
instname_str Universidad Autónoma de Madrid
reponame_str Biblos-e Archivo. Repositorio Institucional de la UAM
collection Biblos-e Archivo. Repositorio Institucional de la UAM
repository.name.fl_str_mv
repository.mail.fl_str_mv
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