Management of bleeding risk in patients who receive anticoagulant therapy for venous thromboembolism: Communication from the ISTH SSC Subcommittee on Predictive and Diagnostic Variables in Thrombotic Disease. (23rd June 2022)

• Record Type: Journal Article
• Authors: den Exter, Paul L.; Woller, Scott C.; Robert‐Ebadi, Helia; Masias, Camila; Morange, Pierre‐Emmanuel; Castelli, David; Hansen, John‐Bjarne; Geersing, Geert‐Jan; Siegal, Deborah M.; de Wit, Kerstin; Klok, Frederikus A.
• Is Part Of: Journal of thrombosis and haemostasis. Volume 20:Number 8(2022)
• Page Start: 1910
• Page End: 1919
• Publication Date: 2022-06-23
• Subjects: anticoagulant treatment -- major bleeding -- prediction model -- risk assessment -- venous thromboembolism; Thrombosis -- Periodicals; Hemostasis -- Periodicals; Blood coagulation disorders -- Periodicals; 616.1
• DOI: 10.1111/jth.15776
• Languages: English
• ISSNs: 1538-7933

Abstract

Abstract: Patients with acute venous thromboembolism (VTE) require anticoagulant therapy to prevent recurrent VTE and death, which exposes them to an inherent increased risk of bleeding. Identification of patients at high risk of bleeding, and mitigating this risk, is an essential component of the immediate and long‐term therapeutic management of VTE. The bleeding risk can be estimated by either implicit judgment, weighing individual predictors (clinical variables or biomarkers), or by risk prediction tools developed for this purpose. Management of bleeding risk in clinical practice is, however, far from standardized. International guidelines are contradictory and lack clear and consistent guidance on the optimal management of bleeding risk. This report of the ISTH subcommittee on Predictive and Diagnostic Variables in Thrombotic Disease summarizes the evidence on the prediction of bleeding in VTE patients. We systematically searched the literature and identified 34 original studies evaluating either predictors or risk prediction models for prediction of bleeding risk on anticoagulation in VTE patients. Based on this evidence, we provide recommendations for the standardized management of bleeding risk in VTE patients.