Predicting the risk for major bleeding in elderly patients with venous thromboembolism using the Charlson index.

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Covadonga Gómez-Cuervo1, Agustina Rivas2, Adriana Visonà3

  • 1Department of Internal Medicine, Hospital Universitario, 12 de Octubre, Avenida de Córdoba s/n 28041, Madrid, Spain. covadonga.gomez@salud.madrid.org.

Journal of Thrombosis and Thrombolysis
|September 18, 2020
PubMed

Insights

The Comorbidity Charlson Index (CCI) shows modest ability to predict major bleeding in elderly patients on anticoagulation for venous thromboembolism (VTE). A CCI score of 4 or less may help identify older VTE patients who benefit more from extended anticoagulation.

Area of Science:

  • Cardiology
  • Geriatrics
  • Hematology

Background:

  • Elderly patients on anticoagulant therapy for venous thromboembolism (VTE) face elevated bleeding risks.
  • Risk stratification is crucial for optimizing extended anticoagulation in this population.

Purpose of the Study:

  • To evaluate the Comorbidity Charlson Index (CCI) prognostic ability for major bleeding in patients aged over 75 years receiving anticoagulation for VTE beyond three months.
  • To assess if CCI improves risk prediction compared to existing scores.

Main Methods:

  • Analysis of data from the RIETE registry, including 4303 patients aged >75 years.
  • Calculation of Area Under the Receiver-Operating Characteristic Curve (AUC), Net Reclassification Index (NRI), and Net Benefit (NB).
  • Assessment of a CCI cut-off of 4 points (CCI4) for predicting major bleeding.

Main Results:

  • The overall AUC for CCI predicting major bleeding was modest (0.569).
  • Patients with CCI ≤ 4 had significantly lower rates of major bleeding and all-cause death compared to those with CCI > 10.
  • CCI4 demonstrated 82% sensitivity and 30% specificity for predicting major bleeding beyond three months.
  • CCI4 reclassification improved the Net Benefit (NB) of the RIETE bleeding score for predicting bleeding.

Conclusions:

  • While the CCI's AUC for predicting major bleeding is modest, it can aid in identifying elderly VTE patients (>75 years) who may benefit more from extended anticoagulation due to lower bleeding risk and better survival.
  • The CCI, particularly a score of 4 or less, offers value in refining risk assessment for extended anticoagulation in older VTE patients.

Keywords:
AgedClinical decisions rulesComorbidityHemorrhageVenous thrombosis

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