The OAC 3-PAD Risk Score Predicts Major Bleeding Events one Year after Hospitalisation for Peripheral Artery Disease

Christian-Alexander Behrendt*, Torben Kreutzburg, Joakim Nordanstig, Chris P Twine, Ursula Marschall, Stavros K Kakkos, Victor Aboyans, Frederik Peters

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

33 Citations (Scopus)
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Abstract

Objective
There is a paucity of evidence concerning the risk of bleeding after hospitalisation for symptomatic peripheral artery disease (PAD) in everyday clinical practice, as randomised clinical trials commonly exclude patients with heightened risk. The current study aimed to develop a pragmatic risk score that enables prediction of major bleeding during the first year after index discharge.
Methods
Unselected retrospective data from the second largest insurance fund in Germany, BARMER, were used to identify patients with a first hospitalisation for PAD registered between 1 January 2010 and 31 December 2018. Within a separate training cohort, final predictors were selected using penalised Cox regression (least absolute shrinkage and selection operator with ten fold cross validation) with one year major bleeding requiring hospitalisation as outcome. The risk score was internally validated. Four different risk groups were constructed.
Results
A total of 81 930 patients (47.2% female, 72.3 years) underwent hospitalisation for symptomatic PAD. After one year, 1 831 (2.2%) of the patients had a major bleeding event. Independent predictors were previous oral anticoagulation, age over 80, chronic limb threatening ischaemia, congestive heart failure, severe chronic kidney disease, previous bleeding event, anaemia, and dementia. The OAC3-PAD risk score exhibited adequate calibration and discrimination between four risk groups (c = 0.69, 95% confidence interval 0.67 – 0.71) from low risk (1.3%) to high risk (6.4%).
Conclusion
A pragmatic risk score was developed to predict the individual major bleeding risk classifying a fifth of the cohort as high risk patients. Individual prediction scores such as the one proposed here may help to inform the risk and benefit of intensified antithrombotic strategies.
Original languageEnglish
Pages (from-to)503-510
Number of pages8
JournalEuropean Journal of Vascular and Endovascular Surgery
Volume63
Issue number3
Early online date4 Feb 2022
DOIs
Publication statusPublished - 1 Mar 2022

Bibliographical note

Funding Information:
This work was supported by the German Federal Joint Committee (grant number 01VSF18035 to CAB).

Funding Information:
J.N. reports honoraria from Bayer, BD, and Medtronic. V.A. reports honoraria and institutional funding from AstraZeneca, Bayer, Boehringer-Ingelheim/Lilly Alliance, BMS/Pfizer Alliance, NovoNordisk, and Vifor. The other authors declare no conflict related to the current study.This work was supported by the German Federal Joint Committee (grant number 01VSF18035 to CAB).

Publisher Copyright:
© 2021 The Author(s)

Keywords

  • Antithrombotics
  • Bleeding
  • Haemorrhage
  • Health services research
  • Outcomes
  • Peripheral artery disease

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