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Master Thesis

Évaluation du risque hémorragique des personnes âgées de plus de 75 ans sous anti-vitamine K, ayant reçu une éducation thérapeutique

Abstract : Introduction: Bleeding is the main complication of anti-vitamin K treatments and particularly for elderly patients for whom risk assessment is complex. The aim of this study is to assess and compare the effectiveness of HAS-BLED and ATRIA scores in predicting bleeding risk for patients over 75. Secondarily, we sought intrinsic and extrinsic factors to the elderly patient having an influence on this risk. Methods: we have carried out a case-control study on 208 patients, 52 cases matching to 156 control patients. These patients, who had been identified during the SCORE study, participated in a therapeutic education programme between May 2009 and May 2010 in four Isère hospitals and were followed for 1 year. The major endpoints, which were collected prospectively, were the occurrence of a major or clinically relevant bleeding event. Results: According to ROC curves, the ATRIA score performed best compared to HAS-BLED in predicting all bleeding events (c-index = 0.59 versus 0.56 respectively) and major bleeding events (c-index = 0.64 against 0.61 respectively). In a multivariate analysis, were associated with an increased risk of bleeding: anemia (OR = 2.6, 95% CI 1.34 to 5.23, p = 0.005), the use of selective serotonin reuptake inhibitors (SSRI) (OR = 2.8, 95% CI 1.08 to 7.47, p = 0.034) and therapy management by the patient's family (OR = 2.8, 95% CI 1.28 to 6.15; p = 0.01). Conclusions: The ATRIA score showed superior performance in predicting bleeding risk and in particular major bleeding risk, for patients over 75 years. It was also improved by taking into account the use of SSRI and treatment management by the patient's family.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-00789663
Contributor : Jean-Hugues Morneau <>
Submitted on : Monday, February 18, 2013 - 3:40:23 PM
Last modification on : Tuesday, May 11, 2021 - 11:36:17 AM
Long-term archiving on: : Sunday, May 19, 2013 - 4:04:00 AM

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  • HAL Id : dumas-00789663, version 1

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Audrey Lebelhomme, Claire Soave. Évaluation du risque hémorragique des personnes âgées de plus de 75 ans sous anti-vitamine K, ayant reçu une éducation thérapeutique. Médecine humaine et pathologie. 2013. ⟨dumas-00789663⟩

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