Service de Médecine Interne et Vasculaire, Hôpital Edouard Herriot, Hospices Civils de Lyon, 69003 Lyon, France; Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), Sorbonne, 75015 Paris, France; Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Université Claude Bernard Lyon 1, Université de Lyon, 69008 Lyon, France; UMR 5305: Laboratoire de Biologie Tissulaire et Ingénierie Thérapeutique, CNRS/Université Claude Bernard Lyon 1, Institut de Biologie et Chimie des Protéines, 7 Passage du Vercors, 69367 Lyon, France.
Service de Médecine Vasculaire et Thérapeutique, Hôpital Universitaire de Saint Etienne, Faculté de Médecine de Saint Etienne, France.; INSERM, UMR1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, F-42055 Saint-Etienne, France; INSERM, CIC-1408, CHU Saint-Etienne, F-42055 Saint-Etienne, France.
Thromb Res. 2022 Jun;214:29-36. doi: 10.1016/j.thromres.2022.04.005. Epub 2022 Apr 13.
The gastrointestinal (GI) tract is a frequent site of bleeding in patients receiving anticoagulant therapy for venous thromboembolism (VTE). At-risk patients have not been consistently identified yet.
We used the RIETE registry to assess the clinical characteristics of patients developing major GI bleeding during the course of anticoagulation. Then, we built a predictive score based on multivariable analysis, aiming to identify patients at increased risk for major GI bleeding.
We included 87,431 patients with acute VTE. During the course of anticoagulation, 778 (0.89%) suffered major GI bleeding, 815 (0.93%) non-major GI bleeding and 1462 (1.67%) had major bleeding outside the GI tract. During the first 30 days after major GI bleeding, 7.6% of patients re-bled, 3.9% had VTE recurrences and 33% died. On multivariable analysis, male sex, age ≥70 years, initial VTE presentation as pulmonary embolism, active cancer, prior VTE, recent major bleeding in the GI tract, esophageal varicosities, anemia, abnormal prothrombin time, renal insufficiency and use of corticosteroids were associated to an increased risk for major GI bleeding. Using the predictive score, 39,591 patients (45%) were at low risk; 36,602 (42%) at intermediate-risk; 9315 (11%) at high-risk; and 1923 (2.2%) at very high risk. Their rates of major GI bleeding were: 0.21%, 0.96%, 2.41% and 6.08%, respectively. The c-statistics was 0.771 (95%CI. 0.755-0.786).
We have developed a score which has the potential to identify patients at increased risk for GI bleeding, but needs to be externally validated."
胃肠道（GI）是接受抗凝治疗静脉血栓栓塞症（VTE）患者出血的常见部位。目前尚未明确高危患者。
我们使用 RIETE 登记处评估了在抗凝过程中发生主要胃肠道出血的患者的临床特征。然后，我们基于多变量分析建立了一个预测评分，旨在识别发生主要胃肠道出血风险增加的患者。
我们纳入了 87431 例急性 VTE 患者。在抗凝过程中，778 例（0.89%）发生主要胃肠道出血，815 例（0.93%）发生非主要胃肠道出血，1462 例（1.67%）发生胃肠道以外的主要出血。在主要胃肠道出血后 30 天内，7.6%的患者再次出血，3.9%的患者发生 VTE 复发，33%的患者死亡。多变量分析显示，男性、年龄≥70 岁、首发 VTE 表现为肺栓塞、活动性癌症、既往 VTE、近期胃肠道大出血、食管静脉曲张、贫血、异常凝血酶原时间、肾功能不全和皮质激素治疗与发生主要胃肠道出血风险增加相关。使用预测评分，39591 例（45%）患者为低危；36602 例（42%）为中危；9315 例（11%）为高危；1923 例（2.2%）为极高危。其主要胃肠道出血发生率分别为：0.21%、0.96%、2.41%和 6.08%。C 统计量为 0.771（95%CI. 0.755-0.786）。
我们开发了一种评分系统，有可能识别胃肠道出血风险增加的患者，但需要外部验证。
