Martinez et al reported a score for predicting the risk of bleeding in a patient being treated with a vitamin K antagonist. The authors are from Institute for Epidemiology, Statistics and Informatics in Frankfurt and Guys and St Thomas NHS Foundation Trust.
Patient selection: therapy with vitamin K antagonist (warfarin, etc)
Outcome: major or clinically relevant bleeding requiring hospitalization within 90 days of therapy initiation
Parameters:
(1) sex
(2) age in years
(3) pulmonary embolism as current thrombotic event
(4) body mass index in kg per square meters
(5) history of major or clinically relevant bleeding
(6) active cancer
(7) trauma or surgical procedure
(8) liver disease
(9) dementia
(10) anemia for 6 months or greater
(11) renal disease
(12) cerebrovascular disease
(13) chronic pulmonary disease
|
Parameter
|
Finding
|
Points
|
|
sex
|
male
|
2
|
|
|
female
|
0
|
|
age in years
|
< 75 years
|
0
|
|
|
>= 75 years
|
1
|
|
pulmonary embolism
|
no
|
0
|
|
|
yes
|
1
|
|
body mass index
|
< 25 kg per sq m
|
1
|
|
|
25 to 29.9
|
0
|
|
|
>= 30 kg per sq m
|
1
|
|
major or relevant bleeding
|
no
|
0
|
|
|
yes
|
1
|
|
active cancer
|
no
|
0
|
|
|
persisting
|
2
|
|
|
post cancer-related thrombosis
|
6
|
|
trauma or surgery
|
no
|
0
|
|
|
yes
|
3
|
|
liver disease
|
no
|
0
|
|
|
yes
|
2
|
|
dementia
|
no
|
0
|
|
|
yes
|
2
|
|
anemia
|
no
|
0
|
|
|
yes
|
1
|
|
renal disease
|
no
|
0
|
|
|
yes
|
1
|
|
cerebrovascular disease
|
no
|
0
|
|
|
yes
|
1
|
|
chronic pulmonary disease
|
no
|
0
|
|
|
yes
|
1
|
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 23
• A score >= 7 is associated with high risk.
Performance:
• The area under the ROC curve is 0.68.
