机构：[1]Bethune First Hospital of Jilin University, Changchun, China.[2]Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.重庆医科大学附属第一医院[3]Department of Pulmonary and Critical Care Medicine, The Second Hospital of Jilin University, Changchun, China.[4]NHC Key Laboratory of Pneumoconiosis, Shanxi Key Laboratory of Respiratory Diseases, Department of Pulmonary and Critical Care Medicine, First Hospital of Shanxi Medical University, Taiyuan, China.[5]Department of Pulmonary and Critical Care Medicine, Beijing Hospital, Beijing, China.[6]Department of Respiratory and Critical Medicine, West China Hospital, Sichuan University, Chengdu, China.四川大学华西医院[7]Department of Pulmonary and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.[8]PUMCH, Dongcheng-qu, China.[9]Department of Pulmonary and Critical Care Medicine, Shanghai East Hospital, Shanghai, China.[10]Harbin Medical University, Harbin, China.[11]Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.[12]Department of Pulmonary and Critical Care Medicine, Xiangya Hospital Central South University, Changsha, China.[13]The First Affiliated Hospital of Dalian Medical University, Dalian, China.大连医科大学附属第一医院[14]The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.[15]Department of Respiratory Neurology, Xinjiang Medical University Affiliated Tumor Hospital, Urumqi, China.[16]Affiliated Hospital of Chengde Medical University, Chengde, China.[17]Department of Respiratory and Critical Care Medicine, Beijing Chaoyang Hospital, Beijing, China.北京朝阳医院[18]China-Japan Friendship Hospital, Capital Medical University, Beijing, China.[19]Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China.[20]China-Japan Friendship School of Clinical Medicine, Beijing University of Chinese Medicine, Beijing, China.[21]Data and Project Management Unit, Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China.[22]Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China.[23]Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China.[24]China-Japan Friendship Hospital, Beijing, China.[25]Department of Radiology, China-Japan Friendship Hospital, Beijing, China.[26]Institute of Basic Medical Sciences,Chinese Academy of Medical Sciences,Peking Union Medical College, Chinese Academy of Medical Sciences Peking Union Medical College, Beijing, China.[27]Department of Epidemiology Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China.[28]Department of Respiratory, China-Japan Friendship Hospital, Beijing, China.
Background Most bleeding risk scores for pulmonary embolism (PE) were developed in patients receiving traditional anticoagulants. Evidence in East Asian populations and their applicability to direct oral anticoagulants (DOACs) remain limited. Methods This post-hoc analysis was based on a multicentre, prospective study (NCT02943343) conducted from 2016 to 2021. The predictive performance of bleeding risk scores was assessed using a time-dependent area under the receiver operating characteristic curve (AUC), net reclassification improvement (NRI), and decision curve analysis (DCA). Propensity score matching (PSM) was adjusted for baseline characteristics. We analysed the impact of initial DOAC versus low molecular weight heparin (LMWH) on outcomes. The endpoint was major bleeding (MB) within 90 days and composite outcomes (all-cause mortality, recurrent VTE, and MB). Results Of 7,619 patients with PE, 1.4% (107 patients) experienced MB within 90 days. The RIETE score showed a modest predictive ability (AUC: 0.70; 95% CI, 0.65-0.75) for predicting 90-day MB and demonstrated a predictive advantage in the DCA results. NRI also revealed significantly better reclassification capability than the other scores, except for HAS-BLED. Among low-risk patients classified by the RIETE score, initial DOAC treatment significantly reduced 14-day composite outcomes compared to LMWH (HR = 0.13; 95% CI, 0.02-0.93). Furthermore, DOACs at discharge did not increase the risk of MB or composite outcomes. Conclusion RIETE score shows modest performance in predicting MB and identifying low bleeding risk in PE patients, which could potentially guide early DOAC use. Further studies are needed to test its clinical utility, especially in East Asian populations.The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
基金：
This study was supported by the CAMS Innovation Fund for Medical Sciences (CIFMS), 2021-I2M-1-049,2021-I2M-1-061, National High Level Hospital Clinical Research Funding, 2022-NHLHCRF-LX-01, National Natural Science Foundation of China,No. 82241029, National Key Research and Development Program of China
第一作者机构：[1]Bethune First Hospital of Jilin University, Changchun, China.
通讯作者：
通讯机构：[1]Bethune First Hospital of Jilin University, Changchun, China.[28]Department of Respiratory, China-Japan Friendship Hospital, Beijing, China.
推荐引用方式(GB/T 7714)：
Tao Yuzhi,Chen Hong,Dong Chunling,et al.Performance of Bleeding Risk Scores for Major Bleeding in Anticoagulated Patients with Pulmonary Embolism: Insights from the CURES Registry-2[J].Thrombosis And Haemostasis.2025,doi:10.1055/a-2642-0241.
APA：
Tao Yuzhi,Chen Hong,Dong Chunling,Zhang Jie,Shi Yiwei...&Zhai Zhenguo.(2025).Performance of Bleeding Risk Scores for Major Bleeding in Anticoagulated Patients with Pulmonary Embolism: Insights from the CURES Registry-2.Thrombosis And Haemostasis,,
MLA：
Tao Yuzhi,et al."Performance of Bleeding Risk Scores for Major Bleeding in Anticoagulated Patients with Pulmonary Embolism: Insights from the CURES Registry-2".Thrombosis And Haemostasis .(2025)
医学