Temporal trends and risk factors of extracranial major bleeding in patients with acute pulmonary embolism.

BACKGROUND

Major bleeding is a crucial event in patients with pulmonary embolism (PE) accompanied by high morbidity and mortality. While the major bleeding research focus primarily on intracranial bleeding, research regarding extracranial major bleeding (ECB) is largely underrepresented.

METHODS

We used the German nationwide inpatient statistics including all hospitalizations of patients admitted due to PE 2016-2020. Hospitalizations were stratified for occurrence of ECB and risk factors for ECB were investigated.

RESULTS

Overall, 283,263 patients were admitted due to PE 2016-2020 in Germany; among them 9378 (3.3%) suffered from ECB. PE patients with ECB were older, more often female, revealed a higher Charlson comorbidity index (CCI; 5.0 [4.0-7.0] vs. 4.0 [2.0-5.0], P < 0.001), were afflicted by prolonged in-hospital stay (13.0 [7.0-22.0] vs 7.0 [4.0-9.0] days, P < 0.001) and higher in-hospital mortality rate (28.3% vs. 7.4%, P < 0.001). ECB was associated with increased in-hospital mortality rate (OR 7.76 [95%CI 7.31-8.24], P < 0.001) and hospitalization costs >20,000€ (OR 24.46 [95%CI 22.25-26.89], P < 0.001). Hospitalization costs were higher in PE with than without ECB (mean: 12.795 vs. 3637€, P < 0.001). Female sex (OR 1.35 [95%CI 1.28-1.42], P < 0.001), higher CCI score (OR 1.25 [95%CI 1.24-1.26], P < 0.001), kidney disease (OR 2.47 [95%CI 2.35-2.60], P < 0.001), heart failure (OR 1.65 [95%CI 1.57-1.73], P < 0.001), cancer (OR 2.01 [95%CI 1.97-2.22], P < 0.001) and hemodynamic instability (OR 12.08 [95%CI 11.38-12.82], P < 0.001) were associated with ECB.

CONCLUSIONS

ECB occurred in 3.3% of the PE hospitalizations and is independently associated with 7.8-fold increased in-hospital mortality rate. Independent risk factors for ECB comprise female sex, hemodynamic status and comorbidity burden.