External validation of risk scores for major bleeding in a population-based cohort of transient ischemic attack and ischemic stroke patients
<strong>Background and Purpose—</strong>The S2TOP-BLEED score may help to identify patients at high risk of bleeding on antiplatelet drugs after a transient ischemic attack or ischemic stroke. The score was derived on trial populations, and its performance in a real-world setting is unkn...
| Main Authors: | , , , , |
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| Format: | Journal article |
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American Heart Association
2018
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| _version_ | 1826300498779570176 |
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| author | Hilkens, N Li, L Rothwell, P Algra, A Greving, J |
| author_facet | Hilkens, N Li, L Rothwell, P Algra, A Greving, J |
| author_sort | Hilkens, N |
| collection | OXFORD |
| description | <strong>Background and Purpose—</strong>The S2TOP-BLEED score may help to identify patients at high risk of bleeding on antiplatelet drugs after a transient ischemic attack or ischemic stroke. The score was derived on trial populations, and its performance in a real-world setting is unknown. We aimed to externally validate the S2TOP-BLEED score for major bleeding in a population-based cohort and to compare its performance with other risk scores for bleeding. <strong>Methods—</strong>We studied risk of bleeding in 2072 patients with a transient ischemic attack or ischemic stroke on antiplatelet agents in the population-based OXVASC (Oxford Vascular Study) according to 3 scores: S2TOP-BLEED, REACH, and Intracranial-B2LEED3S. Performance was assessed with C statistics and calibration plots. <strong>Results—</strong>During 8302 patient-years of follow-up, 117 patients had a major bleed. The S2TOP-BLEED score showed a C statistic of 0.69 (95% confidence interval [CI], 0.64–0.73) and accurate calibration for 3-year risk of major bleeding. The S2TOP-BLEED score was much more predictive of fatal bleeding than nonmajor bleeding (C statistics 0.77; 95% CI, 0.69–0.85 and 0.50; 95% CI, 0.44–0.58). The REACH score had a C statistic of 0.63 (95% CI, 0.58–0.69) for major bleeding and the Intracranial-B2LEED3S score a C statistic of 0.60 (95% CI, 0.51–0.70) for intracranial bleeding. The ratio of ischemic events versus bleeds decreased across risk groups of bleeding from 6.6:1 in the low-risk group to 1.8:1 in the high-risk group. <strong>Conclusions—</strong>The S2TOP-BLEED score shows modest performance in a population-based cohort of patients with a transient ischemic attack or ischemic stroke. Although bleeding risks were associated with risks of ischemic events, risk stratification may still be useful to identify a subgroup of patients at particularly high risk of bleeding, in whom preventive measures are indicated. |
| first_indexed | 2024-03-07T05:18:06Z |
| format | Journal article |
| id | oxford-uuid:ddef7fc1-0b7e-4e2e-861c-f82917b03edc |
| institution | University of Oxford |
| last_indexed | 2024-03-07T05:18:06Z |
| publishDate | 2018 |
| publisher | American Heart Association |
| record_format | dspace |
| spelling | oxford-uuid:ddef7fc1-0b7e-4e2e-861c-f82917b03edc2022-03-27T09:28:26ZExternal validation of risk scores for major bleeding in a population-based cohort of transient ischemic attack and ischemic stroke patientsJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:ddef7fc1-0b7e-4e2e-861c-f82917b03edcSymplectic Elements at OxfordAmerican Heart Association2018Hilkens, NLi, LRothwell, PAlgra, AGreving, J<strong>Background and Purpose—</strong>The S2TOP-BLEED score may help to identify patients at high risk of bleeding on antiplatelet drugs after a transient ischemic attack or ischemic stroke. The score was derived on trial populations, and its performance in a real-world setting is unknown. We aimed to externally validate the S2TOP-BLEED score for major bleeding in a population-based cohort and to compare its performance with other risk scores for bleeding. <strong>Methods—</strong>We studied risk of bleeding in 2072 patients with a transient ischemic attack or ischemic stroke on antiplatelet agents in the population-based OXVASC (Oxford Vascular Study) according to 3 scores: S2TOP-BLEED, REACH, and Intracranial-B2LEED3S. Performance was assessed with C statistics and calibration plots. <strong>Results—</strong>During 8302 patient-years of follow-up, 117 patients had a major bleed. The S2TOP-BLEED score showed a C statistic of 0.69 (95% confidence interval [CI], 0.64–0.73) and accurate calibration for 3-year risk of major bleeding. The S2TOP-BLEED score was much more predictive of fatal bleeding than nonmajor bleeding (C statistics 0.77; 95% CI, 0.69–0.85 and 0.50; 95% CI, 0.44–0.58). The REACH score had a C statistic of 0.63 (95% CI, 0.58–0.69) for major bleeding and the Intracranial-B2LEED3S score a C statistic of 0.60 (95% CI, 0.51–0.70) for intracranial bleeding. The ratio of ischemic events versus bleeds decreased across risk groups of bleeding from 6.6:1 in the low-risk group to 1.8:1 in the high-risk group. <strong>Conclusions—</strong>The S2TOP-BLEED score shows modest performance in a population-based cohort of patients with a transient ischemic attack or ischemic stroke. Although bleeding risks were associated with risks of ischemic events, risk stratification may still be useful to identify a subgroup of patients at particularly high risk of bleeding, in whom preventive measures are indicated. |
| spellingShingle | Hilkens, N Li, L Rothwell, P Algra, A Greving, J External validation of risk scores for major bleeding in a population-based cohort of transient ischemic attack and ischemic stroke patients |
| title | External validation of risk scores for major bleeding in a population-based cohort of transient ischemic attack and ischemic stroke patients |
| title_full | External validation of risk scores for major bleeding in a population-based cohort of transient ischemic attack and ischemic stroke patients |
| title_fullStr | External validation of risk scores for major bleeding in a population-based cohort of transient ischemic attack and ischemic stroke patients |
| title_full_unstemmed | External validation of risk scores for major bleeding in a population-based cohort of transient ischemic attack and ischemic stroke patients |
| title_short | External validation of risk scores for major bleeding in a population-based cohort of transient ischemic attack and ischemic stroke patients |
| title_sort | external validation of risk scores for major bleeding in a population based cohort of transient ischemic attack and ischemic stroke patients |
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