Subject: Anticoagulants
Subject: Venous thromboembolism
Subject: Uterine bleeding
Subject: Prognostic score
Year: 2023
Type: Article
Title: A prognostic score to identify women at increased risk for abnormal uterine bleeding during anticoagulation for venous thromboembolism,
Author: Gabrielle Sarlon-Bartoli,
Author: Juan Criado,
Author: Saskia Middeldorp,
Author: José Antonio Nieto,
Author: María del Carmen Díaz-Pedroche,
Author: Farès Moustafa,
Author: Nuria Ruiz-Giménez,
Author: Benjamin Brenner,
Author: Manuel Monreal,
Author: Pierpaolo DI Micco,
Author: the RIETE Group
Author: Bosevski, Marijan
Author: Zdraveska, Marija
Author: Eftimova A
Abstract: Introduction Little is known about the clinical characteristics of women at increased risk for abnormal uterine bleeding (UB) during anticoagulation for venous thromboembolism (VTE). Methods We used the RIETE registry to identify the baseline characteristics of women developing abnormal UB during anticoagulation. We used logistic regression analysis to identify independent predictors for abnormal UB. Then, we built a prognostic score to identify at-risk women. Results From March 2001 through October 2022, there were 54,372 women with VTE. During anticoagulation (median, 181 days), 318 (0.6%) developed abnormal UB (major bleeding = 88, clinically relevant non-major (CRNM) = 230). On multivariable analysis, women aged <50 years, weighing >70 kg, with uterine cancer, recent UB, anemia, estrogen-related VTE, or receiving rivaroxaban or apixaban were at increased risk for abnormal UB. Using the prognostic score, 42,273 women (78%) were at low-risk, 8,828 (16%) intermediate-, and 3,271 (6.1%) at high-risk for abnormal UB. Their rates of abnormal UB were: 0.28 (95%CI: 0.23–0.35), 1.32 (95%CI: 1.07–1.61) and 7.12 (95%CI: 5.98–8.41) bleeds per 100 patient-years, respectively. The c-statistic was 0.80 (95%CI: 0.77–0.83). The rates of major UB were: 0.06 (95%CI: 0.04–0.09), 0.43 (95%CI: 0.30–0.60) and 1.85 (95%CI: 1.31–2.53) per 100 patient-years, respectively (c-statistic: 0.84; 95%CI: 0.80–0.89). The rates of CRNM uterine bleeding were: 0.21 (95%CI: 0.17–0.26), 0.85 (95%CI: 0.65–1.08), and 5.02 (95%CI: 4.09–6.10) bleeds per 100 patient-years, respectively (c-statistic: 0.78; 95%CI: 0.75–0.82). Conclusions Using 7 variables easily available at admission, we built a prognostic score that reliably identified women with VTE at increased risk for abnormal UB during anticoagulation.
Publisher: Elsevier
Relation: Thrombosis Update
Identifier: oai:repository.ukim.mk:20.500.12188/29307
Identifier: Gabrielle Sarlon-Bartoli, Juan Criado, Saskia Middeldorp, José Antonio Nieto, María del Carmen Díaz-Pedroche, Farès Moustafa, Nuria Ruiz-Giménez, Benjamin Brenner, Manuel Monreal, Pierpaolo DI Micco, Coordinator of the RIETE Registry,RIETE Steering Committee, RIETE National Coordintors, RIETE Registry Coordinating Center: S & H Medical Science Service, Members of the RIETE Group (M. Bosevski, A. Eftimova, M. Zdraveska), A prognostic score to identify women at increased risk for abnormal uterine bleeding during anticoagulation for venous thromboembolism, Thrombosis Update, Volume 13, 2023, 100148, ISSN 2666-5727, https://doi.org/10.1016/j.tru.2023.100148.Identifier: http://hdl.handle.net/20.500.12188/29307Identifier: 10.1016/j.tru.2023.100148
