CO040 | MAJOR BLEEDING IN PATIENTS WITH ACUTE PULMONARY EMBOLISM: RESULTS FROM THE COPE STUDY
Abstract
Background. In patients with acute pulmonary embolism (PE), major bleeding (MB) is the counterbalance for anticoagulant and thrombolytic treatment. We aimed to assess independent predictors of MB, evaluate the performance of available bleeding risk scores, and identify cluster-phenotypes in patients with acute PE from a prospective, multicentre study. Methods. The primary outcome was MB defined according to ISTH criteria occurring during 30-day follow-up. MBs were classified as early (<7 days) and late (≥7 days) based on days from PE diagnosis. Results. Among 5,213 patients with acute PE, 159 had MB (3.1%), 78 were early, and 81 were late events. MB occurred in 12.9% and 2.5% of patients treated vs. not treated with thrombolysis. Active cancer, previous bleeding, dementia, anemia, syncope, and thrombolysis were independent predictors of early MB, and of MB at 30 days; active cancer, previous bleeding, and anemia were independent predictors of late MB. Four patient phenotypes were identified: #1= previous VTE/estrogen users, #2= unprovoked PE, #3= cancer patients, and #4= fragile patients with comorbidities. The risk of MB was lower in the previous VTE (#1) cluster-phenotype in comparison to the others, with a trend toward increased risk from phenotype #1 to #4. Performance of phenotypes to predict MB at 30 days was similar to that of PE-SARD, BACS, and VTE-Bleed. Conclusions. In patients with acute PE, risk factors for early and late MB within 30 days differ. Compared to stratification strategies that are solely based on bleeding predictors, phenotyping appears to offer similar accuracy in identifying patients at risk for MB.
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BibTeX
@article{cimini2026co040,
title = {{CO040 | MAJOR BLEEDING IN PATIENTS WITH ACUTE PULMONARY EMBOLISM: RESULTS FROM THE COPE STUDY}},
author = {Ludovica Anna Cimini},
journal = {Bleeding, Thrombosis and Vascular Biology},
year = {2026},
month = oct,
url = {https://www.btvb.org/btvb/article/view/742},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - CO040 | MAJOR BLEEDING IN PATIENTS WITH ACUTE PULMONARY EMBOLISM: RESULTS FROM THE COPE STUDY
AU - Ludovica Anna Cimini
PY - 2026
DA - 2026/10/26
JO - Bleeding, Thrombosis and Vascular Biology
UR - https://www.btvb.org/btvb/article/view/742
AB - Background. In patients with acute pulmonary embolism (PE), major bleeding (MB) is the counterbalance for anticoagulant and thrombolytic treatment. We aimed to assess independent predictors of MB, evaluate the performance of available bleeding risk scores, and identify cluster-phenotypes in patients with acute PE from a prospective, multicentre study. Methods. The primary outcome was MB defined according to ISTH criteria occurring during 30-day follow-up. MBs were classified as early (<7 days) and late (≥7 days) based on days from PE diagnosis. Results. Among 5,213 patients with acute PE, 159 had MB (3.1%), 78 were early, and 81 were late events. MB occurred in 12.9% and 2.5% of patients treated vs. not treated with thrombolysis. Active cancer, previous bleeding, dementia, anemia, syncope, and thrombolysis were independent predictors of early MB, and of MB at 30 days; active cancer, previous bleeding, and anemia were independent predictors of late MB. Four patient phenotypes were identified: #1= previous VTE/estrogen users, #2= unprovoked PE, #3= cancer patients, and #4= fragile patients with comorbidities. The risk of MB was lower in the previous VTE (#1) cluster-phenotype in comparison to the others, with a trend toward increased risk from phenotype #1 to #4. Performance of phenotypes to predict MB at 30 days was similar to that of PE-SARD, BACS, and VTE-Bleed. Conclusions. In patients with acute PE, risk factors for early and late MB within 30 days differ. Compared to stratification strategies that are solely based on bleeding predictors, phenotyping appears to offer similar accuracy in identifying patients at risk for MB.
SN - 2785-5309
ER -