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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\u003Cp id=\u0022p-1\u0022\u003EA secondary analysis of pooled data from the EINSTEIN-DVT and EINSTEIN-PE studies demonstrated the utility of 4 different bleeding risk scores to identify patients with deep vein thrombosis or pulmonary embolism who are at a low risk of bleeding. Patients aged \u0026lt;\u200565 years and without a history of bleeding or significant comorbidities had a rate of major bleeding of \u0026lt;\u20050.5% at 30 days.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EDeep vein thrombosis\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EEINSTEIN-DVT study\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EEINSTEIN-PE study\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Emajor bleeding\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Epulmonary embolism\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Erivaroxaban\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Evenous thromboembolism\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EVTE\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\u003Cp id=\u0022p-2\u0022\u003EFour bleeding risk scores identified patients with deep vein thrombosis (DVT) or pulmonary embolism (PE) who had a low rate of major bleeding at 30 days when treated with rivaroxaban, according to Jeffrey A. Kline, MD, Indiana University School of Medicine, Indianapolis, Indiana, USA.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThe investigators hypothesized that the rate of major bleeding associated with rivaroxaban treatment would be \u0026lt;\u20051% when using a bleeding risk scoring system derived to predict a low risk of bleeding in patients with venous thromboembolism (VTE) treated with a vitamin K antagonist. They used pooled data from the EINSTEIN-DVT and EINSTEIN-PE studies and found a low rate of major bleeding in the patients treated with rivaroxaban (1%; 40 of 4150 patients) [Prins MH et al. \u003Cem\u003EThromb J\u003C\/em\u003E. 2013]. Rivaroxaban was given at 15 mg twice daily for 21 days and then 20 mg once daily for 3 to 12 months.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe 4150 rivaroxaban-treated patients were stratified as low, moderate, or high risk using each of the 4 bleeding risk scores [Ruiz-Gimenez N et al. \u003Cem\u003EThromb Haemost\u003C\/em\u003E. 2008; Kuijer PM et al. \u003Cem\u003EArch Intern Med\u003C\/em\u003E. 1999; Beyth RJ et al. \u003Cem\u003EAm J Med\u003C\/em\u003E. 1998; Landefeld CS et al. \u003Cem\u003EJ Clin Epidemiol\u003C\/em\u003E. 1989]. SMQ codes were used to extract data from the case report forms and any missing data were considered normal. The ISTH definition of major bleeding was used.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EThe primary outcome was the rate of major bleeding at 30 days and for the total treatment duration. During the critical 30-day period after discharge, there was a low rate of major bleeding in the low-risk patients and the confidence intervals were \u0026lt;\u20051 at 30 days and for the entire study period. The proportion of patients defined as low risk ranged from 28.7% to 63.6% depending on the score.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EThe characteristics associated with low risk were age \u0026lt;\u200565 years, no history of bleeding, and no comorbid conditions (current cancer, renal insufficiency, diabetes mellitus, anemia, prior stroke or myocardial infarction). These criteria identified a subgroup of patients in the EINSTEIN studies who were at low risk of bleeding and had a rate of major bleeding of \u0026lt;\u20050.5% at 30 days. Thus, patients with VTE aged \u0026lt;\u200565 years with no bleeding history or significant comorbidities can be counseled that they have a \u0026lt;\u20051 in 100 chance of experiencing a major bleeding event during the first 30 days of treatment with rivaroxaban, concluded Dr Kline. Dr Kline postulated that these bleeding risk scores could be applied in the emergency room to identify low-risk patients who may be safely discharged from the emergency department with a novel oral anticoagulant.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 SAGE Publications\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/15\/28\/22.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzl4sp\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}