Prediction and cumulative incidence of in-hospital bleeding among acutely ill medical patients receiving pharmacologic VTE prophylaxis based on the IMPROVE-BRS: a retrospective single-center cohort
J Catangui, H I Sampao, M M Yu, N Pestano, E AlajarAbstract
Introduction
Pharmacologic prophylaxis against venous thromboembolism (VTE) reduces thrombotic events but increases bleeding risk. The International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) Bleeding Risk Score (BRS) is the only externally validated tool for predicting in-hospital bleeding; however, previous studies evaluated patients before initiating prophylaxis. This study aimed to validate the IMPROVE BRS among Filipino medical inpatients who were already receiving prophylaxis, reflecting real-world clinical practice.
Purpose
This study sought to evaluate the predictive performance of the IMPROVE Bleeding Risk Score in identifying major and clinically relevant non-major bleeding among Filipino medical inpatients receiving pharmacologic VTE prophylaxis. Specifically, it aimed to determine the score’s discrimination, diagnostic accuracy, and clinical utility in a real-world hospital setting.
Methods
This retrospective cohort included 152 adult medical inpatients at our Hospital who received pharmacologic VTE prophylaxis. Baseline clinical data were used to compute the IMPROVE BRS, classifying patients as low (<7) or high (≥7) risk. Bleeding incidence and predictors were analyzed using logistic regression, relative risk ratios, and receiver operating characteristic (ROC) analysis.
Results
Bleeding occurred in 15.1% of patients (9.9% major; 5.3% clinically relevant non-major). High-risk patients had a fourfold higher risk of major bleeding (RR 4.0, 95% CI 1.3–12.4). The IMPROVE BRS showed a sensitivity of 73.9%, specificity of 54.3%, PPV of 22.4%, NPV of 92.1%, and AUROC of 0.83, indicating moderate to good discrimination.
Conclusion
The IMPROVE BRS remains a valid and practical bedside tool even during active pharmacologic prophylaxis, effectively identifying low-risk patients and supporting individualized, safer thromboprophylaxis in Filipino medical inpatients.IMPROVE-BRS diagnostic accuracyIMPROVE-BRS AUROC