Assessing the Performance of Bleeding Scores in High-Risk VTE Patients

A study aimed to systematically evaluate the performance of bleeding scores in patients with VTE focusing on high-risk patients. The findings appeared in the European Journal of Internal Medicine.

Researchers searched Medline and Cochrane Library, as well as reviews and references of retrieved articles. They discerned sensitivity, specificity, positive likelihood ratio (LR+), and diagnostic odds ratio (DOR) of the ‘high risk’ category of each bleeding score. Subsequently, random effects meta-analysis w performed in order to derive the central estimates and 95% confidence intervals (95% CI). Overall, the analysis included 21 studies and 10 bleeding scores.

The results found that VTE-BLEED displayed the highest sensitivity, but the second-lowest specificity (Se 76%; Sp 61%), followed by ACCP (Se 59%; Sp 57%). The researchers observed that the remaining scores had high specificity (> 80%), but a low sensitivity (< 20%). HEMORR₂HAGES and Niewenhuis score showed the best performance regarding LR+ that was 2.67 and 5.91, respectively. Regarding DOR, the Niewenhuis score and VTE-BLEED were the best performers with 9.04; 95% CI 3.87-21.09 and 4.94 95% CI 2.66-9.09, respectively. In a cohort with patients predominantly treated with direct oral anticoagulants (DOACs), VTE-BLEED had the highest sensitivity (Se 77%; Sp 60%).

“Overall, the majority of the risk scores showed a moderate ability to forecast major bleeding events, with the VTE-BLEED as the most sensitive in patients treated with DOACs,” the researchers concluded.