Gomez-Cuervo et al evaluated older adults on oral anticoagulation following deep vein thrombosis. The Charlson Comorbidity Index (CCI) can help to identify a patient who is at low risk for a major bleed on extended therapy. The authors are from multiple institutions from around the world and belong to RIETE.
Patient: age > 75 years on oral anticoagulation for deep vein thrombosis for 3 months
Goal: identify an older adult for whom the benefits of therapy beyond 3 months outweighs the risks
A Charlson Comorbidity Index <= 4 is at low risk for major bleeding on extended therapy.
A patient with a CCI > 4 is at greater risk for major bleeding, fatal bleeding and death from other cause. The risk is higher if the CCI is > 10.
This can be used in conjunction with the RIETE score for major bleeding.
Performance:
• The area under the ROC curve is 0.57.
• The cutoff CCI > 4 has a negative predictive value of 98%.
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