Factors at Admission Associated With Bleeding Risk in Medical Patients

Findings From the IMPROVE Investigators


      Acutely ill, hospitalized medical patients are at risk of VTE. Despite guidelines for VTE prevention, prophylaxis use in these patients is still poor, possibly because of fear of bleeding risk. We used data from the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) to assess in-hospital bleeding incidence and to identify risk factors at admission associated with in-hospital bleeding risk in acutely ill medical patients.


      IMPROVE is a multinational, observational study that enrolled 15,156 medical patients. The in-hospital bleeding incidence was estimated by Kaplan-Meier analysis. A multiple regression model analysis was performed to identify risk factors at admission associated with bleeding.


      The cumulative incidence of major and nonmajor in-hospital bleeding within 14 days of admission was 3.2%. Active gastroduodenal ulcer (OR, 4.15; 95% CI, 2.21-7.77), prior bleeding (OR, 3.64; 95% CI, 2.21-5.99), and low platelet count (OR, 3.37; 95% CI, 1.84-6.18) were the strongest independent risk factors at admission for bleeding. Other bleeding risk factors were increased age, hepatic or renal failure, ICU stay, central venous catheter, rheumatic disease, cancer, and male sex. Using these bleeding risk factors, a risk score was developed to estimate bleeding risk.


      We assessed the incidence of major and clinically relevant bleeding in a large population of hospitalized medical patients and identified risk factors at admission associated with in-hospital bleeding. This information may assist physicians in deciding whether to use mechanical or pharmacologic VTE prophylaxis.
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      Linked Article

      • Can We IMPROVE Bleeding Risk Assessment for Acutely Ill, Hospitalized Medical Patients?
        ChestVol. 139Issue 1
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          VTE encompasses DVT and pulmonary embolism (PE), and treating these conditions places a colossal burden on the US health-care system, costing > $1.5 billion per year.1 VTE is preventable; yet, it is the third most common cardiovascular disease, after heart disease and stroke,2 with one in 1,000 people in the United States experiencing VTE for the first time each year.3 VTE is potentially fatal if the first presentation is with massive PE. Medical patients who are acutely ill, immobile, and at high risk (ie, postmyocardial infarction, ischemic stroke), and those with other risk factors for development of hypercoagulation, such as active cancer, previous VTE, or severe respiratory disease, are predisposed to a greater risk of VTE4 and warrant thromboprophylaxis with low-molecular-weight heparin (LWMH), low-dose unfractionated heparin (UFH), or fondaparinux while hospitalized.
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