PT  - JOURNAL ARTICLE
AU  - Luis Jara-Palomares
AU  - David Jiménez
AU  - Behnood Bikdeli
AU  - Alfonso Muriel
AU  - Parth Rali
AU  - Yugo Yamashita
AU  - Takeshi Morimoto
AU  - Takeshi Kimura
AU  - Raphael Le Mao
AU  - Antoni Riera-Mestre
AU  - Ana Maestre
AU  - Fares Moustafa
AU  - Manuel Monreal
ED  - ,
TI  - Derivation and validation of a clinical prediction rule for thrombolysis-associated major bleeding in patients with acute pulmonary embolism: the BACS score
AID  - 10.1183/13993003.02336-2020
DP  - 2020 Dec 01
TA  - European Respiratory Journal
PG  - 2002336
VI  - 56
IP  - 6
4099  - http://erj.ersjournals.com/content/56/6/2002336.short
4100  - http://erj.ersjournals.com/content/56/6/2002336.full
SO  - Eur Respir J2020 Dec 01; 56
AB  - Background Improved prediction of the risk of major bleeding in patients with acute pulmonary embolism (PE) receiving systemic thrombolysis is crucial to guide the choice of therapy.Methods The study included consecutive patients with acute PE who received systemic thrombolysis in the RIETE registry. We used multivariable logistic regression analysis to create a risk score to predict 30-day major bleeding episodes. We externally validated the risk score in patients from the COMMAND VTE registry. In addition, we compared the newly created risk score against the Kuijer and RIETE scores.Results Multivariable logistic regression identified four predictors for major bleeding: recent major bleeding (3 points), age >75 years (1 point), active cancer (1 point) and syncope (1 point) (BACS). Among 1172 patients receiving thrombolytic therapy in RIETE, 446 (38%) were classified as having low risk (none of the variables present, 0 points) of major bleeding according to the BACS score, and the overall 30-day major bleeding rate of this group was 2.9% (95% CI 1.6–4.9%), compared with 44% (95% CI 14–79%) in the high-risk group (>3 points). In the validation cohort, 51% (149 out of 290) of patients were classified as having low risk, and the overall 30-day major bleeding rate of this group was 1.3%. In RIETE, the 30-day major bleeding event rates in the Kuijer and RIETE low-risk strata were 5.3% and 4.4%, respectively.Conclusions The BACS score is an easily applicable aid for prediction of the risk of major bleeding in the population of PE patients who receive systemic thrombolysis.The BACS score, based on easily available patient characteristics, could support physicians in their assessment of the risk of bleeding with systemic thrombolysis for acute pulmonary embolism https://bit.ly/3eVd0SH