Thromb Haemost 2017; 117(02): 246-251
DOI: 10.1160/TH16-07-0588
Coagulation and Fibrinolysis
Schattauer GmbH

Risk factors for intracranial haemorrhage in patients with pulmonary embolism treated with thrombolytic therapy Development of the PE-CH Score

Saurav Chatterjee
1  Division of Cardiology, St. Lukes-Roosevelt Hospital Center of the Mount Sinai Health System, New York, New York, USA
*  Current affiliation:-Temple University Hospitals, Philadelphia, Pennsylvania, USA
,
Ido Weinberg
2  The Institute for Heart, Vascular, & Stroke Care, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
,
Robert W. Yeh
3  Cardiovascular Division, Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
,
Anasua Chakraborty
4  Division of Pulmonology and Critical Care, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
,
Partha Sardar
5  Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah, USA
,
Mitchell D. Weinberg
6  Department of Cardiology, Northshore University Hospital, Manhasset, New York, USA
,
Christopher Kabrhel
7  Center for Vascular Emergencies, Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
,
Geoffrey D. Barnes
8  Cardiovascular Medicine Division, University of Michigan Medical School, Ann Arbor, Michigan, USA
,
Debabrata Mukherjee
9  Division of Cardiology, Texas Tech University, El Paso, Texas, USA
,
Dharam Kumbhani
10  Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
,
Riyaz Bashir
11  Division of Cardiology, Temple University Medical School, Philadelphia, Pennsylvania, USA
,
Anjali Vaidya
12  Cardiovascular Medicine Division, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
*  Current affiliation:-Temple University Hospitals, Philadelphia, Pennsylvania, USA
,
Akaya Smith
13  Pulmonary & Critical Care Division, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
,
Barry Fuchs
13  Pulmonary & Critical Care Division, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
,
Peter Groeneveld
14  Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
,
Jay Giri
12  Cardiovascular Medicine Division, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
› Author Affiliations
Further Information

Publication History

Received:29 July 2016

Accepted after major revision:19 October 2016

Publication Date:
01 December 2017 (online)

Summary

Pulmonary embolism (PE) is a major cause of morbidity and mortality world-wide, and the use of thrombolytic therapy has been associated with favourable clinical outcomes in certain patient subsets. These potential benefits are counterbalanced by the risk of bleeding complications, the most devastating of which is intracranial haemorrhage (ICH). We retrospectively evaluated 9703 patients from the 2003–2012 nationwide in-patient sample database (NIS) who received thrombolytics for PE. All patients with ICH during the PE hospitalisation were identified and a clinical risk score model was developed utilizing demographics and comorbidities. The dataset was divided 1:1 into derivation and validation cohorts. During 2003–2012, 176/9705 (1.8 %) patients with PE experienced ICH after thrombolytic use. Four independent prognostic factors were identified in a backward logistic regression model, and each was assigned a number of points proportional to its regression coefficient: pre-existing Peripheral vascular disease (1 point), age greater than 65 years (Elderly) (1 point), prior Cerebrovascular accident with residual deficit (5 points), and prior myocardial infarction (Heart attack) (1 point). In the derivation cohort, scores of 0, 1, 2 and ≥ 5 points were associated with ICH risks of 1.2 %, 1.9 %, 2.4 % and 17.8 %, respectively. Rates of ICH were similar in the validation cohort. The C-statistic for the risk score was 0.65 (0.61–0.70) in the derivation cohort and 0.66 (0.60–0.72) in the validation cohort. A novel risk score, derived from simple clinical historical elements was developed to predict ICH in PE patients treated with thrombolytics.

Supplementary Material to this article is available online at www.thrombosis-online.com.