Performance of five different bleeding-prediction scores in patients with acute pulmonary embolism

J Thromb Thrombolysis. 2016 Feb;41(2):312-20. doi: 10.1007/s11239-015-1239-x.


Bleeding-prediction scores may help guiding management of patients with pulmonary embolism (PE), although no such score has been validated. We aimed to externally validate and compare two bleeding-prediction scores for venous thromboembolism to three scores developed for patients with atrial fibrillation in a real-world cohort of PE patients. We performed a prospective observational cohort study in 448 consecutive PE patients who were treated with heparins followed by vitamin-K-antagonists. The Kuijer, RIETE, HEMORR2HAGES, HAS-BLED and ATRIA scores were assessed at baseline. All patients were followed for the occurrence of major bleeding over a 30-day period. The accuracies of both the overall, original 3-level and newly defined optimal 2-level outcome of the scores were evaluated and compared, both for the 30-day period as well as for bleeding occurring in versus after the first week of treatment. 20 of 448 patients suffered major bleeding resulting in a cumulative incidence of 4.5 % (95 % CI 2.5-6.5). The predictive power of all five scores for bleeding was poor (c-statistics 0.57-0.64), both for the 3-level and 2-level score outcomes. No individual score was found to be superior. The HAS-BLED score had a good c-statistic for bleedings occurring after the first week of treatment (0.75, 95 % CI 0.47-1.0). Current available scoring systems have insufficient accuracy to predict overall anticoagulation-associated bleeding in patients treated for acute PE. To optimally target bleeding-prevention strategies, the development of a high quality PE-specific risk score is urgently needed.

Keywords: Atrial fibrillation; Bleeding; Prevention; Pulmonary embolism; Risk score.

Publication types

  • Clinical Trial
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Aged
  • Aged, 80 and over
  • Female
  • Hemorrhage* / blood
  • Hemorrhage* / chemically induced
  • Hemorrhage* / mortality
  • Heparin* / administration & dosage
  • Heparin* / adverse effects
  • Humans
  • Male
  • Predictive Value of Tests
  • Prospective Studies
  • Pulmonary Embolism* / blood
  • Pulmonary Embolism* / drug therapy
  • Pulmonary Embolism* / mortality
  • Registries*
  • Risk Assessment
  • Vitamin K / antagonists & inhibitors*


  • Vitamin K
  • Heparin