Background: Estimation of bleeding risk is an unmet need for individualized therapy in acute pulmonary embolism (PE) patients with increased mortality risk.
Aims: To form a new score that is easy to use and can detect PE patients at low risk for major bleeding (MB) who may benefit from thrombolysis.
Methods: This is a retrospective cross-sectional study that included consecutive PE patients who received thrombolysis using a tissue-plasminogen activator (tPA). Patients’ characteristics on admission to the hospital were analyzed with regard to the occurrence of major bleeding during the first 7 days. Major bleeding was defined according to the modified International Society of Thrombosis and Haemostasis (ISTH) criteria (“overt” bleeding is the only modification from the original criteria). Pulmonary embolism bleeding score index (PEBSI) was created using multivariate regression analyses, and finely, the dichotomous index was used for the discrimination of patients at low risk for MB from those at high risk.
Results: Overall 367 PE patients were treated with tPA during the 6-year period (2015-2021). Among them, 29 (7.9%) fulfilled the criteria for MB. Five factors were identified as significantly associated with MB and were used to build the PEBSI score: previous bleeding, recent surgery, diabetes, the use of drugs that could be associated with bleeding, and anemia. PEBSI score showed significant prediction power for 7-day MB revealing a c-index value of 0.794 (95CI% 0.698-0.889). Patients with PEBSI scores of 0 or 1 had a low risk for MB (2.8%) and those with scores>1 had a high risk for MB (18.6%) (p < 0.001). Internal validation of the PEBSI score using a randomly, equally split method confirmed the discriminative value of the PEBSI score.
Conclusion(s): Novel PEBSI score has significant power to discriminate patients at low risk for MB on thrombolytic therapy from those at high risk.
To cite this abstract in AMA style:
Dzudovic B, Subotic B, Neskovic A, Matijasevic J, Salinger S, Dzudovic J, Obradovic S. PEBSI – Pulmonary Embolism Bleeding Score Index [abstract]. https://abstracts.isth.org/abstract/pebsi-pulmonary-embolism-bleeding-score-index/. Accessed March 22, 2024.« Back to ISTH 2022 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/pebsi-pulmonary-embolism-bleeding-score-index/