Prediction of severe bleeding after coronary surgery: the WILL-BLEED Risk Score

Fausto Biancari; Debora Brascia; Francesco Onorati; Daniel Reichart; Andrea Perrotti; Vito G. Ruggieri; Giuseppe Santarpino; Daniele Maselli; Giovanni Mariscalco; Riccardo Gherli; Antonino S. Rubino; Marisa De Feo; Giuseppe Gatti; Francesco Santini; Magnus Dalén; Matteo Saccocci; Eeva-Maija Kinnunen; Juhani K. E. Airaksinen; Paola D’Errigo; Stefano Rosato; Francesco Nicolini

doi:10.1160/TH16-09-0721

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2017; 117(03): 445-456
DOI: 10.1160/TH16-09-0721

Coagulation and Fibrinolysis

Schattauer GmbH

Prediction of severe bleeding after coronary surgery: the WILL-BLEED Risk Score

Fausto Biancari

¹Department of Surgery, Oulu University Hospital, Oulu, Finland

,

Debora Brascia

¹Department of Surgery, Oulu University Hospital, Oulu, Finland

,

Francesco Onorati

²Division of Cardiovascular Surgery, Verona University Hospital, Verona, Italy

,

Daniel Reichart

³Hamburg University Heart Center, Hamburg, Germany

,

Andrea Perrotti

⁴Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France

,

Vito G. Ruggieri

⁵Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France

,

Giuseppe Santarpino

⁶Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany

,

Daniele Maselli

⁷Department of Cardiac Surgery, St. Anna Hospital, Catanzaro, Italy

,

Giovanni Mariscalco

⁸Department of Cardiovascular Sciences, Clinical Science Wing, University of Leicester, Glenfield Hospital, Leicester, UK

,

Riccardo Gherli

⁹Unit of Cardiac Surgery, Department of Cardiosciences, Hospital S. Camillo-Forlanini, Rome, Italy

,

Antonino S. Rubino

¹⁰Centro Cuore Morgagni, Pedara, Italy

,

Marisa De Feo

¹¹Division of Cardiac Surgery, Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy

,

Giuseppe Gatti

¹²Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy

,

Francesco Santini

¹³Division of Cardiac Surgery, University of Genoa, Genoa, Italy

,

Magnus Dalén

¹⁴Department of Molecular Medicine and Surgery, Department of Cardiothoracic Surgery and Anesthesiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden

,

Matteo Saccocci

¹⁵Department of Cardiac Surgery, Centro Cardiologico–Fondazione Monzino IRCCS, University of Milan, Italy

,

Eeva-Maija Kinnunen

¹Department of Surgery, Oulu University Hospital, Oulu, Finland

,

Juhani K. E. Airaksinen

¹⁶Heart Center, Turku University Hospital, Turku, Finland

,

Paola D’Errigo

¹⁸Division of Cardiac Surgery, University of Parma, Parma, Italy

,

Stefano Rosato

¹⁸Division of Cardiac Surgery, University of Parma, Parma, Italy

,

Francesco Nicolini

¹⁷National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanitá, Rome, Italy

› Institutsangaben

Abstract

Summary

Severe perioperative bleeding after coronary artery bypass grafting (CABG) is associated with poor outcome. An additive score for prediction of severe bleeding was derived (n=2494) and validated (n=1250) in patients from the E-CABG registry. Severe bleeding was defined as E-CABG bleeding grades 2–3 (transfusion of >4 units of red blood cells or reoperation for bleeding). The overall incidence of severe bleeding was 6.4 %. Preoperative anaemia (3 points), female gender (2 points), eGFR <45 ml/min/1.73 m2 (3 points), potent antiplatelet drugs discontinued less than five days (2 points), critical preoperative state (5 points), acute coronary syndrome (2 points), use of low-molecular-weight heparin/fondaparinux/unfractionated heparin (1 point) were independent predictors of severe bleeding. The WILL-BLEED score was associated with increasing rates of severe bleeding in both the derivation and validation cohorts (scores 0–3: 2.9 % vs 3.4 %; scores 4–6: 6.8 % vs 7.5 %; scores>6: 24.6 % vs 24.2 %, both p<0.0001). The WILL-BLEED score had a better discriminatory ability (AUC 0.725) for prediction of severe bleeding compared to the ACTION (AUC 0.671), CRUSADE (AUC 0.642), Papworth (AUC 0.605), TRUST (AUC 0.660) and TRACK (AUC 0.640) bleeding scores. The net reclassification index and integrated discrimination improvement using the WILL-BLEED score as opposed to the other bleeding scores were significant (p<0.0001). The decision curve analysis demonstrated a net benefit with the WILL-BLEED score compared to the other bleeding scores. In conclusion, the WILL-BLEED risk score is a simple risk stratification method which allows the identification of patients at high risk of severe bleeding after CABG.

Clinical Trial Registration: NCT02319083 (https://clinicaltrials.gov/ct2/show/NCT02319083)

Keywords

Bleeding - coronary artery bypass grafting - CABG - cardiac surgery - risk score

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Referenzen

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