Background
Venous thromboembolism (VTE), including both deep vein thrombosis and pulmonary embolism (PE) affects approximately 1-2 adults per 1000 individuals every year. VTE constitute a major global burden of disease. Current international guidelines recommend treatment with anticoagulant therapy after VTE for a duration of at least 3 months. Since anticoagulation also imposes an increased risk for bleeding events, the individual risk has to be evaluated to determine adequate treatment plans. Thus, the objective of our study was to investigate the usage of the Kuijer score to predict major bleeding events such as intracerebral bleeding as well as in-hospital death, major adverse cardiac and cerebrovascular events and other adverse events during in-hospital stay.

Methods 

The nationwide German inpatient sample of the years 2005-2017 was used for this analysis. Hospitalized VTE patients were stratified according to Kuijer risk class and the performance of the Kuijer score was evaluated to predict adverse in-hospital events.

Results

Overall, 1,204,895 VTE patients were treated between 2005-2017 in Germany and were included in the present study (839,143 patients had deep venous thrombosis and/or thrombophlebitis and 669,881 patients with pulmonary embolism). According to the Kuijer risk class stratification, in total, 176,723 (14.7%) of the hospitalized VTE patients were classified as low risk, 914,964 (75.9%) as intermediate risk and 113,208 (9.4%) as high risk.
A higher Kuijer risk class was predictive for in-hospital death (OR 1.99 [95%CI 1.96-2.02],P<0.001), major adverse cardiovascular and cerebrovascular events (MACCE, OR 1.90 [95%CI 1.87-1.93],P<0.001), intracerebral bleeding (OR 1.28 [95%CI 1.14-1.44],P<0.001), gastrointestinal bleeding (OR 1.56 [95%CI 1.48-1.64],P<0.001) as well as necessity of transfusion of blood constituents (OR 2.94 [95%CI 2.88-3.00],P<0.001) independently of important comorbidities.

Conclusions

The Kuijer score is an important risk stratification tool to predict individual risk regarding in-hospital outcomes comprising major bleeding events such as intracerebral bleeding and necessity of transfusion of blood constituents, but also in-hospital mortality and MACCE in VTE patients.