What are the Area Under the Curve (AUC) values for Venous Thromboembolism (VTE)-BLEED, RIETE, VTE-PREDICT, CHA2DS2-VASc (CHAP), and Anti-Coagulant Bleeding (ABC)-bleeding scores?

AUC Values for VTE Risk Scoring Systems

The PESI score has the highest documented AUC value of 0.87 for predicting 30-day mortality in pulmonary embolism patients, while the VTE-BLEED score has an AUC of 0.72-0.75 for predicting major bleeding events during stable anticoagulation. 1, 2

VTE-BLEED Score

• VTE-BLEED was developed to predict bleeding events in patients on stable anticoagulation after venous thromboembolism 2
• AUC of 0.72 (95% CI 0.67-0.76) for overall bleeding prediction during the complete follow-up period 2
• For prediction of major bleeding after day 30 ("stable" anticoagulation):
  • AUC of 0.75 (95% CI 0.61-0.89) in patients on dabigatran
  • AUC of 0.78 (95% CI 0.68-0.86) in patients on warfarin 2
• In the XALIA study validation, VTE-BLEED showed good predictive value for major bleeding after day 30 and day 90 3

RIETE Score

• RIETE score was derived from the Registro Informatizado de la Enfermedad TromboEmbólica registry 1, 4
• AUC ranging between 0.69 and 0.72 for predicting major bleeding across different time periods (first 30 days, days 31-90, days 91-180, and days 181-360) 4
• Performs better for predicting early extracranial bleeding compared to intracranial hemorrhages 4

Comparison of VTE-BLEED and RIETE

• Both scores showed similar performance with AUCs ranging between 0.69 and 0.72 across different time periods 4
• RIETE score was more useful for early extracranial bleeding prediction 4
• VTE-BLEED was more useful for late intracranial hemorrhage prediction 4
• Positive predictive values for both scores were low (0.6-3.9%), being better for early major bleeding than for later periods 4

PESI and sPESI Scores

• PESI (Pulmonary Embolism Severity Index) score:
  • AUC of 0.77 (95% CI 0.75 to 0.79) in internal validation 1
  • AUC of 0.87 in external validation for predicting 90-day mortality 1
• sPESI (Simplified Pulmonary Embolism Severity Index):
  • Derived from RIETE registry data 1
  • Non-inferior to PESI in predicting 30-day mortality 1
  • Specific AUC value not provided in the available evidence 1

CHAP (CHA₂DS₂-VASc) Score

• While mentioned in the question, specific AUC values for CHAP/CHA₂DS₂-VASc in VTE risk assessment were not provided in the available evidence
• This score is primarily used for stroke risk assessment in atrial fibrillation patients 1

ABC-Bleeding Score

• While mentioned in the question, specific AUC values for ABC-bleeding were not provided in the available evidence

VTE-PREDICT Score

• While mentioned in the question, specific AUC values for VTE-PREDICT were not provided in the available evidence

Clinical Implications

• When selecting a risk score, clinicians should consider the specific outcome they want to predict (mortality, bleeding, recurrent VTE) 5
• The usefulness of available bleeding scores may vary depending on the patient population characteristics and the time frame evaluated 4
• Dynamic scoring approaches that can be updated throughout treatment may be more useful than static scores assessed only at baseline 4
• Most bleeding risk scores have only modest predictive value for patients with VTE 6