RIETE Score for Risk of Hemorrhage in Pulmonary Embolism Treatment

id

1786

full_title

RIETE Score for Risk of Hemorrhage in Pulmonary Embolism Treatment

short_title

RIETE Score

med_description

Determine the risk of major bleeding during anticoagulant therapy.

description

The RIETE Score for Risk of Hemorrhage in PE Treatment determines the risk of major bleeding during anticoagulant therapy for pulmonary embolism.

keywords

bleeding complication, RIETE calculator, RIETE bleeding, bleeding anticoagulation, major bleeding risk, RIETE registry, RIETE, pulmonary embolism bleeding risk, PE bleeding risk, PE hemorrhage risk, PE treatment risk

complaint

[ "Chest Pain", "Shortness of Breath" ]

formula

Addition of the selected points, see below:

evidence

measurements

[]

information

refrences

{ "Clinical Practice Guidelines": [], "Manufacturer Website": [], "Original/Primary Reference": [ { "href": "https://www.ncbi.nlm.nih.gov/pubmed/18612534", "text": "Ruíz-Giménez N, Suárez C, González R, Nieto JA, Todolí JA, Samperiz AL, Monreal M; RIETE Investigators. Predictive variables for major bleeding events in patients presenting with documented acute venous thromboembolism. Findings from the RIETE Registry.Thromb Haemost. 2008 Jul;100(1):26-31. doi: 10.1160/TH08-03-0193." } ], "Other References": [], "Outcomes": [], "Validation": [ { "href": "https://www.ejinme.com/article/S0953-6205(08)00032-0/abstract", "text": "Guijarro, Ricardo et al. Venous thromboembolism in Spain. Comparison between an administrative database and the RIETE registry. European Journal of Internal Medicine , Volume 19 , Issue 6 , 443 - 446." } ], "Validations": [] }

pearls

The RIETE registry developed a clinical score to stratify a patient’s risk of major bleeding with anticoagulation for DVT or PE.

• Included all patients with symptomatic acute DVT or PE diagnosed by CTV or US for DVT and pulmonary angiography, lung scintigraphy or helical CT for PE
• Scoring system consisted of 6 criteria, 1 of which was worth 2 points, 2 worth 1.5 points each, and 3 worth 1 point each
• The study used 0 points to define low risk for major bleeding events (0.1% risk of bleeding), 1-4 points for intermediate risk (2.8% risk), and >4 points for high risk (6.2% risk)
• Major bleeding was defined as overt bleeding plus one of the following:
  • Required transfusion of 2+ units of blood,
  • Retroperitoneal, spinal or intracranial, OR
  • Fatal

Points to keep in mind:

• Study used same population for derivation and validation cohorts
• Did not distinguish between different types of anticoagulation
• Anemia was never defined
• Score has not been externally validated. The only validation study to date utilized the same RIETE database and used a different endpoint.

A subsequent risk score has been developed by the ATRIA group which also used similar criteria in their score to determine risk of bleeding after anti-coagulation with warfarin for atrial fibrillation. They also had a similar overall bleeding rate as the RIETE group.

usecase

Consider using the RIETE score to stratify patients’ risk for bleeding after anti-coagulation for DVT/PE in conjunction with situation specific risks/benefits.

reasons

The RIETE score is based on a very large cohort of patients and, if validated, has a significant difference in outcomes between the low and high risk groups, making it a potentially powerful tool to guide the decision to anticoagulate.

next_advice

next_actions

• Risks and benefits of anti-coagulation should be carefully considered in ALL patients prior to initiating therapy
• Alternative options should often be considered in patients with high-risk of major bleeding events in need of anti-coagulation

next_management

diseases

[ "Pulmonary Embolism" ]

instructions

published

2022-04-21T20:29:01.232Z

purpose

[ "Prognosis" ]

search_terms

[ "pulm", "reite", "pe", "lovenox", "coumadin", "warfarin" ]

seo

{ "keywords_en": "bleeding complication, RIETE calculator, RIETE bleeding, bleeding anticoagulation, major bleeding risk, RIETE registry, RIETE, pulmonary embolism bleeding risk, PE bleeding risk, PE hemorrhage risk, PE treatment risk", "meta_description_en": "The RIETE Score for Risk of Hemorrhage in PE Treatment determines the risk of major bleeding during anticoagulant therapy for pulmonary embolism." }

specialty

[ "Cardiology", "Critical Care", "Emergency Medicine", "Hematology and Oncology", "Hospitalist Medicine", "Pulmonology" ]

departments

[ "Cardiac", "Hematologic", "Respiratory" ]

tags

[]

version_number

1

versions

[]

related

[ { "calcId": 1718, "short_title_en": "ATRIA Bleeding Risk", "slug": "atria-bleeding-risk-score" }, { "calcId": 1247, "short_title_en": "Simplified PESI", "slug": "simplified-pesi-pulmonary-embolism-severity-index" }, { "calcId": 1304, "short_title_en": "PESI Score", "slug": "pulmonary-embolism-severity-index-pesi" } ]

ismed

true

section

[ "whenToUseViewed", "pearlsPitfallsViewed", "whyUseViewed", "nextStepsViewed", "evidenceViewed" ]

cleaned_departments

[ "cardiology", "hematology", "pulmonology" ]

cleaned_use

[ "Consider using the RIETE score to stratify patients’ risk for bleeding after anti-coagulation for DVT/PE in conjunction with situation specific risks/benefits." ]

pub

true