Abstract Number: PB2348
Meeting: ISTH 2020 Congress
Background: Despite the practice guidelines, venous thromboprophylaxis remains to be improved in China where the utilization of anticoagulants is suboptimal, partially due to the perceived bleeding risks.
Aims: To assess the in-hospital major bleeding incidences and to identify the risk factors associated with major bleeding in medical and surgical inpatients.
Methods: DissolVE-2 was a multicentre, observational, cross-sectional study (ChiCTR-OOC-16010187) that screened patients for eligibility between March and September 2016 in 44 major cities at 60 teaching hospitals with >500 beds. We used data from DissolVE-2 study to assess in-hospital major bleeding incidence and to identify risk factors at admission associated with in-hospital major bleeding risk. Logistic regression analysis was used to calculate odds ratio to assess association between risk and covariates.
Results: Of the 13,609 patients (6,986 surgical and 6,623 medical) analysed, mean age was 63.2±15.65 years, and 57.5% were males. The cumulative incidence of in-hospital major bleeding in medical and surgical patients was 3.5% and 2.8%, respectively (Figure 1). The significant risk factors associated with major bleeding in medical patients were active gastroduodenal cancer, bleeding within 3-months before hospitalization, platelet count< 50X109/L, hepatic failure, severe renal failure, ICU or CCU admission and central venous catheter. In surgical patients aged ≥ 85 years, coagulation dysfunction, antiplatelet therapy, diabetes, severe renal/ hepatic failure, abdominal surgery, cardiac surgery, craniotomy, spinal trauma were the major risk factors (Table 1). The bleeding risk scoring system developed showed higher incidence of major bleeding in medical patients with ≥3 than < 3 (11.3% vs. 0.5%) and surgical patients with score ≥ 4 than < 4 (12.4 vs. 0.9%).
Conclusions: We developed the major bleeding risk scoring system based on the independent risk factors associated with major bleeding. This information would assist physicians in prescribing an appropriate prophylaxis to reduce the risk of VTE in hospitalized patients at risk of major bleeding.
|Risk factors in medical patients||Odds Ratio (95% CI）||P-Value||Risk factors in surgical patients||Odds Ratio（95% CI）||P-Value|
|Active gastroduodenal ulcer||6.04 (1.68, 21.73)||0.006||Age≥85 y (vs<40 y)||5.86 (1.42, 24.27)||0.015|
|Bleeding in 3 months before admission||6.12 (2.61, 14.38)||<0.001||Coagulation dysfunction||7.22 (1.81, 28.79)||0.005|
|Platelet count <50×10 9/L||5.71 (2.77, 11.76)||<0.001||Concomitant use of antiplatelet therapy||4.11 (1.57, 10.75)||0.004|
|Hepatic failure (INR＞1.5)||9.56 (2.33, 39.28)||<0.001||Severe renal or hepatic failure||2.68 (1.08, 6.68)||0.034|
|Severe renal failure（GFR＜30 mL/min/m2）||4.51 (2.21, 9.18)||<0.001||History of diabetes||2.719 (1.2, 6.06)||0.014|
|ICU or CCU admission||2.54 (1.18, 5.48)||0.017||Abdominal surgery||6.62 (3.81, 11.52)||<0.001|
|Central venous catheter||2.96 (1.43. 6.13)||0.004||Cardiac surgery||10.24 (2.56, 40.96)||0.001|
|Craniotomy||9.28 (4.79, 17.98)||<0.001|
|Spinal trauma||8.37 (2.83, 24.72)||<0.001|
[Table 1: Significant risk factors associated with major bleeding based on multivariate logistic regression analysis in medical and surgical patients]
To cite this abstract in AMA style:Zhang Z, Zhai Z-, Qin X-, Shi Y-, Xu R-, Li W-, Xu Y-, Qu J-, Wang C. Factors Associated with Major Bleeding Risk in Medical and Surgical Patients: Findings from a Multi-Center, Cross-Sectional Study (DissolVE-2) [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/factors-associated-with-major-bleeding-risk-in-medical-and-surgical-patients-findings-from-a-multi-center-cross-sectional-study-dissolve-2/. Accessed January 28, 2022.
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