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A New Hybrid Quantitative Evaluation Model for Axillary Junctional Hemorrhage in Swine
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Definition of major bleeding: Prognostic classification.

Laura Franco1, Cecilia Becattini1, Jan Beyer-Westendorf2

  • 1Vascular and Emergency Medicine-Stroke Unit, University of Perugia, Perugia, Italy.

Journal of Thrombosis and Haemostasis : JTH
|August 9, 2020
PubMed
Summary
This summary is machine-generated.

This study proposes a new classification for major bleeding (MB) events in patients on anticoagulants, stratifying risk for short-term death. The classification helps identify "serious," "severe," and "life-threatening" bleeding based on specific clinical factors.

Keywords:
anticoagulantsbleedingclassificationhemorrhagemortality

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Area of Science:

  • Hematology
  • Clinical Medicine
  • Pharmacology

Background:

  • The International Society of Thrombosis and Haemostasis (ISTH) provides a widely accepted definition for major bleeding (MB).
  • However, the ISTH definition does not adequately differentiate the variable short-term mortality risk associated with MB events.
  • This limitation impacts risk stratification and management of patients on anticoagulant therapy.

Purpose of the Study:

  • To develop and validate a classification system for ISTH-defined major bleeding events.
  • The classification aims to predict the risk of short-term death in patients experiencing MB while on oral anticoagulants.
  • To improve risk stratification for patients with major bleeding.

Main Methods:

  • A derivation cohort of patients experiencing ISTH-defined MB while on oral anticoagulants was established.
  • A validation cohort of similar patients was used to confirm the findings.
  • The primary outcome assessed was death within 30 days of the MB event.

Main Results:

  • In the derivation cohort (517 patients), 64 died; in the validation cohort (560 patients), 63 died.
  • Glasgow Coma Scale (GCS) <14 and shock were significant predictors of death in the derivation cohort.
  • A classification was proposed: "serious," "severe," and "life-threatening" MBs, based on intracranial hemorrhage with GCS <14 or non-ICH MB with shock.

Conclusions:

  • ISTH-defined major bleeding events can be stratified according to their short-term risk of death.
  • The proposed classification, incorporating GCS and shock, aids in identifying high-risk bleeding events.
  • This stratification can inform clinical management and resource allocation for patients with major bleeding.