Clinical outcome of patients with major bleeding after venous thromboembolism

José Antonio Nieto; Timoteo Camara; Elena Gonzalez-Higueras; Nuria Ruiz-Gimenez; Ricardo Guijarro; Pablo Javier Marchena; Manuel Monreal; for the RIETE Investigators

doi:10.1160/TH08-06-0390

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2008; 100(05): 789-796
DOI: 10.1160/TH08-06-0390

Blood Coagulation, Fibrinolysis and Cellular Haemostasis

Schattauer GmbH

Clinical outcome of patients with major bleeding after venous thromboembolism

Findings from the RIETE Registry^[*]

Authors

José Antonio Nieto

¹Servicio de Medicina Interna, Hospital Virgen de la Luz, Cuenca, Spain
Timoteo Camara

¹Servicio de Medicina Interna, Hospital Virgen de la Luz, Cuenca, Spain
Elena Gonzalez-Higueras

¹Servicio de Medicina Interna, Hospital Virgen de la Luz, Cuenca, Spain
Nuria Ruiz-Gimenez

²Servicio de Medicina Interna, Hospital de la Princesa, Madrid, Spain
Ricardo Guijarro

³Servicio de Medicina Interna, Hospital Carlos Haya de Málaga, Spain
Pablo Javier Marchena

⁴Servicio de Medicina Interna, Hospital de Sant Boi (Barcelona), Spain
Manuel Monreal

⁵Professor of Medicine, Servicio de Medicina Interna, Hospital Universitari Germans Trias i Pujol, Badalona, Spain

for the RIETE Investigators

Abstract

Summary

The natural history of patients with venous thromboembolism (VTE) who develop a major bleeding complication while on anticoagulant therapy is not well known. RIETE is a prospective registry of consecutive patients with symptomatic, objectively confirmed, acute VTE. The clinical characteristics, treatment decisions and outcome of all VTE patients who had major bleeding during the first three months of anticoagulant therapy were retrospectively studied. As of January 2007, 17,368 patients were included in RIETE. Of these, 407 (2.3%) had major bleeding during the study period: 144 gastrointestinal, 119 haematoma, 51 intracranial, 43 genitourinary, 50 other. In 286 (69%) patients anticoagulant therapy was discontinued, in 74 (18%) not modified, in 38 (9.1%) a vena cava filter was inserted. During the first 30 days after bleeding, 24 (5.9%) patients re-bled, 20 (4.9%) had recurrent VTE, 133 (33%) died. Of these, 75 died of bleeding, 12 of recurrent pulmonary embolism. Most deaths occurred shortly after the bleeding episode (median:1 day).On multivariate analysis, insertion of a vena cava filter was the only variable independently associated with a lower incidence of fatal bleeding (odds ratio [OR]: 0.10; 95% confidence interval [CI]: 0.01–0.79) and all-cause mortality (OR: 0.21; 95%CI: 0.07–0.63). In conclusion, the occurrence of major bleeding in patients with VTE is outstanding in terms of overall mortality (33% within 30 days), fatal bleeding (18%) or re-bleeding (5.9%). However, these patients also have an increased incidence of recurrent VTE (4.9%) and fatal pulmonary embolism (1.2%).

Keywords

Venous thromboembolism - major bleeding - anticoagulant therapy - outcome

Full Text

References

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