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Thromb Haemost 2017; 117(03): 445-456
DOI: 10.1160/TH16-09-0721
Coagulation and Fibrinolysis
Schattauer GmbH

Prediction of severe bleeding after coronary surgery: the WILL-BLEED Risk Score

Fausto Biancari
1   Department of Surgery, Oulu University Hospital, Oulu, Finland
,
Debora Brascia
1   Department of Surgery, Oulu University Hospital, Oulu, Finland
,
Francesco Onorati
2   Division of Cardiovascular Surgery, Verona University Hospital, Verona, Italy
,
Daniel Reichart
3   Hamburg University Heart Center, Hamburg, Germany
,
Andrea Perrotti
4   Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France
,
Vito G. Ruggieri
5   Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France
,
Giuseppe Santarpino
6   Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany
,
Daniele Maselli
7   Department of Cardiac Surgery, St. Anna Hospital, Catanzaro, Italy
,
Giovanni Mariscalco
8   Department of Cardiovascular Sciences, Clinical Science Wing, University of Leicester, Glenfield Hospital, Leicester, UK
,
Riccardo Gherli
9   Unit of Cardiac Surgery, Department of Cardiosciences, Hospital S. Camillo-Forlanini, Rome, Italy
,
Antonino S. Rubino
10   Centro Cuore Morgagni, Pedara, Italy
,
Marisa De Feo
11   Division of Cardiac Surgery, Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy
,
Giuseppe Gatti
12   Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy
,
Francesco Santini
13   Division of Cardiac Surgery, University of Genoa, Genoa, Italy
,
Magnus Dalén
14   Department of Molecular Medicine and Surgery, Department of Cardiothoracic Surgery and Anesthesiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
,
Matteo Saccocci
15   Department of Cardiac Surgery, Centro Cardiologico–Fondazione Monzino IRCCS, University of Milan, Italy
,
Eeva-Maija Kinnunen
1   Department of Surgery, Oulu University Hospital, Oulu, Finland
,
Juhani K. E. Airaksinen
16   Heart Center, Turku University Hospital, Turku, Finland
,
Paola D’Errigo
18   Division of Cardiac Surgery, University of Parma, Parma, Italy
,
Stefano Rosato
18   Division of Cardiac Surgery, University of Parma, Parma, Italy
,
Francesco Nicolini
17   National Center for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanitá, Rome, Italy
› Author Affiliations
Further Information

Publication History

Received: 21 September 2016

Accepted after major revision: 28 October 2016

Publication Date:
28 November 2017 (online)

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Predicting bleeding risk after coronary surgery: Let’s focus on modifiable risk factors and simple, practical decision makingThromb Haemost 2017; 117(04): 647-649
DOI: 10.1160/TH17-02-0131

Summary

Severe perioperative bleeding after coronary artery bypass grafting (CABG) is associated with poor outcome. An additive score for prediction of severe bleeding was derived (n=2494) and validated (n=1250) in patients from the E-CABG registry. Severe bleeding was defined as E-CABG bleeding grades 2–3 (transfusion of >4 units of red blood cells or reoperation for bleeding). The overall incidence of severe bleeding was 6.4 %. Preoperative anaemia (3 points), female gender (2 points), eGFR <45 ml/min/1.73 m2 (3 points), potent antiplatelet drugs discontinued less than five days (2 points), critical preoperative state (5 points), acute coronary syndrome (2 points), use of low-molecular-weight heparin/fondaparinux/unfractionated heparin (1 point) were independent predictors of severe bleeding. The WILL-BLEED score was associated with increasing rates of severe bleeding in both the derivation and validation cohorts (scores 0–3: 2.9 % vs 3.4 %; scores 4–6: 6.8 % vs 7.5 %; scores>6: 24.6 % vs 24.2 %, both p<0.0001). The WILL-BLEED score had a better discriminatory ability (AUC 0.725) for prediction of severe bleeding compared to the ACTION (AUC 0.671), CRUSADE (AUC 0.642), Papworth (AUC 0.605), TRUST (AUC 0.660) and TRACK (AUC 0.640) bleeding scores. The net reclassification index and integrated discrimination improvement using the WILL-BLEED score as opposed to the other bleeding scores were significant (p<0.0001). The decision curve analysis demonstrated a net benefit with the WILL-BLEED score compared to the other bleeding scores. In conclusion, the WILL-BLEED risk score is a simple risk stratification method which allows the identification of patients at high risk of severe bleeding after CABG.

Clinical Trial Registration: NCT02319083 (https://clinicaltrials.gov/ct2/show/NCT02319083)

Keywords

Bleeding - coronary artery bypass grafting - CABG - cardiac surgery - risk score

 

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