0
Original Research: ANTITHROMBOTIC THERAPY |

Factors at Admission Associated With Bleeding Risk in Medical Patients: Findings From the IMPROVE Investigators

Hervé Decousus, MD; Victor F. Tapson, MD, FCCP; Jean-François Bergmann, MD; Beng H. Chong, MD, PhD; James B. Froehlich, MD, MPH; Ajay K. Kakkar, MD, PhD; Geno J. Merli, MD; Manuel Monreal, MD; Mashio Nakamura, MD; Ricardo Pavanello, MD; Mario Pini, MD; Franco Piovella, MD; Frederick A. Spencer, MD; Alex C. Spyropoulos, MD, FCCP; Alexander G. G. Turpie, MD; Rainer B. Zotz, MD; Gordon FitzGerald, PhD; Frederick A. Anderson, PhD; for the IMPROVE Investigators
Author and Funding Information

From the INSERM, CIE3, the University Saint-Etienne, and CHU Saint-Etienne, Hôpital Nord, Service de Médecine Interne et Thérapeutique (Dr Decousus), Saint-Etienne, France; Hôpital Lariboisiere Clinique Thérapeutique (Dr Bergmann), University Paris Diderot, Paris, France; Duke University Medical Center (Dr Tapson), Durham, NC; St. George Clinical School (Dr Chong), University of New South Wales, Sydney, NSW, Australia; the Department of Vascular Medicine (Dr Froehlich), University of Michigan Health System, Ann Arbor, MI; Centre for Surgical Sciences (Dr Kakkar), Barts and The London, Queen Mary School of Medicine, London, England; Jefferson Vascular Diseases Center (Dr Merli), the Departments of Surgery and Medicine, Thomas Jefferson University Hospital, Philadelphia, PA; Servicio de Medicina Interna (Dr Monreal), Hospital Germans Trias i Pujol, Badalona, Spain; the Department of Cardiology (Dr Nakamura), Mie University Graduate School of Medicine, Tsu Mie, Japan; Hospital do Coracao Clinica Medica São Paulo (Dr Pavanello), São Paulo, Brazil; Medicina Interna II (Dr Pini), Fidenza Hospital, Parma, Italy; U.O. Angiologia (Dr Piovella), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Hamilton Health Sciences General Hospital (Drs Spencer, Spyropoulos, and Turpie), Hamilton, ON, Canada; Hämostase-Institut Düsseldorf (Dr Zotz), Düsseldorf, Germany; and the Center for Outcomes Research (Drs FitzGerald and Anderson), University of Massachusetts Medical School, Worcester, MA.

Correspondence to: Hervé Decousus, MD, Service de Médecine et Thérapeutique, Groupe de recherche sur la thrombose (EA 3065), Centre d’Investigation Clinique CIE3 (INSERM/DHOS) Hôpital Nord, Bâtiment A, Niveau 0, CHU Saint-Etienne, 42055 Saint-Etienne Cedex 2, France; e-mail: herve.decousus@chu-st-etienne.fr


For editorial comment see page 10

Funding/Support: The IMPROVE study was supported by an unrestricted educational grant from Sanofi-Aventis to the Center for Outcomes Research at the University of Massachusetts Medical School.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;139(1):69-79. doi:10.1378/chest.09-3081
Text Size: A A A
Published online

Background:  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.

Methods:  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.

Results:  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.

Conclusions:  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.

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543