Thrombosis research
October 18, 2026 · via Europe PMC
Predictive performance of bleeding risk scores for extended anticoagulation in pulmonary embolism: Insights from the CURES-2 registry.
Liang R, Tao Y, Dong C, +23 more, CURES investigators.
AI summary — for doctors, generated from the abstract only
VTE-BLEED was the best of six bleeding scores for predicting major bleeding during extended anticoagulation after pulmonary embolism, though only modestly.
What was studied
Registry cohort analysis (CURES) of 4896 PE patients on extended anticoagulation comparing six bleeding scores for 1-year major bleeding.
Key findings
- Only 18 patients (0.4%) had major bleeding.
- VTE-BLEED had the highest time-dependent AUC (0.72) and best calibration (Brier 0.0039).
- AUCs exceeded 0.70 for both VKA and DOAC subgroups.
Clinical relevance
Supports using VTE-BLEED at the 3-month decision point on extended anticoagulation.
Who should care
Limitations
Very few bleeding events and follow-up attrition make estimates imprecise.
Use VTE-BLEED as an aid, not a sole decider, for extended anticoagulation in PE.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Background
Bleeding risk assessment is critical at the 3-month decision point for extended anticoagulation in patients with pulmonary embolism (PE), yet it remains unclear which existing bleeding risk score best predicts bleeding during the extended phase.
Methods
Based on the CURES cohort, this study enrolled patients with PE undergoing extended-phase anticoagulation, which was defined as regular anticoagulant therapy for ≥90 days. We compared the performance of 6 bleeding risk scores (PE-SARD, BACS, Kuijer, RIETE, HAS-BLED, and VTE-BLEED) in predicting major bleeding (MB) events within 1 year during the extended phase. The predictive performance was assessed through time-dependent area under the receiver operating characteristic curves, calibration curves, and decision curve analysis.
Results
A total of 4896 patients with acute PE receiving extended-phase anticoagulation were included in the study, among whom 18 patients (0.4%) experienced major bleeding. Compared with the other 5 bleeding scores, VTE-BLEED exhibited the highest predictive accuracy (time-dependent AUC = 0.72; 95% CI: 0.63-0.81), accompanied by superior overall calibration (Brier score = 0.0039). In subgroup analyses by anticoagulant type, VTE-BLEED maintained favorable robustness with AUCs exceeding 0.70 for patients treated with either VKAs or DOACs.
Conclusions
VTE-BLEED offers potential utility for guiding risk-stratified management of MB during extended anticoagulation in patients with PE, particularly at the 3-month reassessment point. Nonetheless, the limited number of MB events and follow-up attrition necessitate cautious interpretation and further validation in larger prospective studies.
DOI
10.1016/j.thromres.2026.109892
PMID
42906223
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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