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    Poster Networking

    Venous Thromboembolism

    Poster Networking Session

    PB0479 - The ABC-bleeding score for prediction of on-treatment clinically relevant bleeding in patients with unprovoked venous thromboembolism: results from the prospective PLATO-VTE study

    Sunday, June 25, 2023
    18:30 – 19:30 ET
    Room: Exhibition

      Presenting Author(s)

    • NG

      Noori A.M Guman, MD

      PhD Student
      Dept. of Vascular Medicine, Amsterdam UMC location AMC, University of Amsterdam, Amsterdam, The Netherlands
      Amsterdam, Noord-Holland, Netherlands

      • Co-Author(s)

    • AB

      Anne-Marie L. Becking

      PhD student
      Dept. of Vascular Medicine, Amsterdam UMC location AMC, University of Amsterdam, Amsterdam, The Netherlands
      Amsterdam, Noord-Holland, Netherlands

    • NK

      Noémie Kraaijpoel

      MD
      Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
      Amsterdam, Noord-Holland, Netherlands

    • FM

      Frits I. Mulder

      PhD student
      Dept. of Vascular Medicine, Amsterdam UMC location AMC, University of Amsterdam, Amsterdam, The Netherlands
      Amsterdam, Noord-Holland, Netherlands

    • Marc Carrier, MD

      MD, MSc
      Ottawa Hospital Research Institute, Ottawa, ON, Canada
      Ottawa, Ontario, Canada

    • LJ

      Luis Jara-Palomares

      Senior consultant
      Hospital Universitario Virgen del Rocío, Seville, Spain
      Sevilla, Andalucia, Spain

    • MD

      Marcello Di Nisio

      MD
      Department of Medicine and Ageing Sciences, University G. D'Annunzio, Chieti, Italy
      Chieti, Abruzzi, Italy

    • Walter Ageno, MD (he/him/his)

      Professor of Medicine
      Department of Medicine and Surgery, University of Insubria, Varese, Italy
      Varese, Lombardia, Italy

    • Jan Beyer-Westendorf, MD,PhD

      Head of Division "Thrombosis and Hemostasis", Head of „Thrombosis Research“
      University Hospital “Carl Gustav Carus”, Technische Universität Dresden, Division of Hematology and Hemostasis, Department of Medicine I Thrombosis Research, Dresden, Saxony, Germany
      Dresden, Sachsen, Germany

    • Erik Klok, MD, PhD, FESC

      Leiden University Medical Center

    • Thomas Vanassche, MD PhD

      MD, PhD
      University Hospitals Leuven, Belgium
      Leuven, Vlaams-Brabant, Belgium

    • HO

      Hans-Martin M.B. Otten

      MD
      Dept. of Internal Medicine, Meander Medisch Centrum, Amersfoort, the Netherlands
      Amersfoort, Utrecht, Netherlands

    • BC

      Benilde Cosmi

      Associate Professor
      Dept. of Angiology and Blood Coagulation, S. Orsola-Malpighi University Hospital, IRCSS -University of Bologna, Bologna, Italy
      Bologna, Emilia-Romagna, Italy

    • MP

      Mike J.L. Peters

      MD
      Dept. of Internal Medicine, UMC Utrecht, Utrecht, the Netherlands
      Utrecht, Utrecht, Netherlands

    • Mt

      Marije ten Wolde

      MD
      Dept. of Internal Medicine, Flevo Hospital, Almere, the Netherlands
      Almere, Flevoland, Netherlands

    • PB

      Patrick M.M. Bossuyt

      Professor of Clinical Epidemiology
      Dept. of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
      Amsterdam, Noord-Holland, Netherlands

    • VG

      Victor E.A. Gerdes

      MD
      Dept. of Vascular Medicine, Amsterdam UMC location AMC, University of Amsterdam, Amsterdam, The Netherlands
      Amsterdam, Noord-Holland, Netherlands

    • HB

      Harry R. Büller

      MD
      Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
      Amsterdam, Noord-Holland, Netherlands

    • PK

      Pieter W. Kamphuisen

      MD
      Tergooi MC and Amsterdam University Medical Centers
      Hilversum, Noord-Holland, Netherlands

    • Nick van Es, MD PhD (he/him/his)

      MD
      Department of Vascular Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
      Amsterdam, Noord-Holland, Netherlands

    Background: Extended anticoagulant treatment beyond 3-6 months should not be offered to patients with unprovoked venous thromboembolism (VTE) and high bleeding risk, however, guidance on bleeding-risk assessment is lacking. The biomarker-based ABC-bleeding score appeared predictive of major bleeding in atrial fibrillation populations, but its value in patients with unprovoked VTE is unclear.

    Aims: To assess the performance of ABC-bleeding, compared to RIETE, VTE-BLEED, and CHAP, proposed for VTE populations, in predicting clinically relevant bleeding after unprovoked VTE.

    Methods: In this subanalysis of PLATO-VTE, an international prospective cohort study of patients ≥40 years with a first unprovoked VTE, we calculated bleeding risk estimates at time of VTE diagnosis. Multiple imputation was used for missing data. The primary outcome was on-treatment clinically relevant bleeding during 24-month follow-up. Discrimination was evaluated by areas under the receiver operating characteristic curves (AUROC). The cohort was divided in high and low-risk groups, using positivity thresholds as described in the derivation studies. Cumulative bleeding incidences were estimated in high- and low-risk groups with Kaplan-Meier analyses and compared using a Cox regression model.

    Results: We included 514 patients of whom 38 (7.4%) had a bleeding event during follow-up (Table). AUROCs were 0.50 (95%-CI: 0.46-0.53) for ABC-bleeding and 0.49-0.51 for the other tools. The proportion of patients classified as high risk was 33% with ABC-bleeding, versus 1.4% with RIETE, 37% with VTE-BLEED, and 30% with CHAP. With ABC-bleeding, the 24-month cumulative bleeding incidence was 12.2% (95%-CI: 6.6-17.8) in the high and 7.4% (95%-CI: 4.3-10.5) in the low-risk group (hazard ratio: 1.67, 95%-CI: 0.86-3.21); for the other tools this ranged from 0.0% to 12.1% in high-risk, and 7.8% to 9.1% in low-risk groups. Differences between high and low-risk groups were not statistically significant (Figure).

    Conclusion(s): In our cohort, the four evaluated tools showed poor performance for prediction of clinically relevant bleeding during VTE treatment.