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  • Title: Bleeding and venous thromboembolism arising in acutely ill hospitalized medical patients. Findings from the Spanish national discharge database.
    Author: Guijarro R, San Roman C, Arcelus JI, Montes-Santiago J, Gómez-Huelgas R, Gallardo P, Monreal M.
    Journal: Eur J Intern Med; 2014 Feb; 25(2):137-41. PubMed ID: 24200547.
    Abstract:
    BACKGROUND: There is scarce evidence to identify which acutely ill medical patients might benefit from prophylaxis against venous thromboembolism (VTE). METHODS: The Spanish National Discharge Database was used to identify predictors of bleeding and VTE during hospitalization for an acute medical illness. RESULTS: Of 1,148,301 patients, 3.10% bled, 1.21% were diagnosed with VTE, and 8.64% died. The case-fatality rate was: 20.8% for bleeding and 19.7% for VTE. Eight clinical variables were independently associated with an increased risk for VTE and bleeding, one with a decreased risk for both events, 4 with an increased risk for VTE and a decreased risk for bleeding, 2 with an increased risk for bleeding but a decreased risk for VTE, and 1 with a decreased risk for bleeding. When all these variables were considered, we composed a risk scoring system, in which we assigned points to each variable according to the ratio between the odds ratio for bleeding and for VTE. Overall, 21% of patients scored less than 0 points and had a bleeding vs. VTE ratio of 1.19; 55% scored 0 to 1.0 points and had a ratio of 2.13; and 24% scored over 1.0 points and had a ratio of 6.10. CONCLUSIONS: A risk score based on variables documented at admission can identify patients with different ratios (near 1.0; about 2.0; and >6.0) between the rate of bleeding and of VTE.
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