试用

试用概览证据贡献者

说明

For patient newly diagnosed with acute deep vein thrombosis (DVT) or pulmonary embolism (PE) at the time of anticoagulation initiation.
Not intended for:
- Pediatric patients.
- Pregnancy or postpartum-associated VTE.
- Unusual-site thrombosis (e.g., cerebral venous sinus thrombosis, splanchnic vein thrombosis).
- Critically ill ICU populations.

Recent major bleeding

Major bleeding in the derivation study was defined as overt bleeding plus ≥1 of the following:
- Requirement for transfusion of ≥2 units of blood.
- Retroperitoneal, spinal, or intracranial bleeding.
- Fatal bleeding.

The RIETE score was developed from the RIETE registry (a large international registry of patients with confirmed acute venous thromboembolism) to predict the risk of major bleeding within three months of anticoagulant therapy in patients with acute venous thromboembolism. It was derived and validated on 19,274 patients, with 13,057 used for derivation and 6,572 for validation.

Risk Factors Identified

On multivariable analysis, six variables were independently associated with major bleeding risk and assigned points.

Risk Factor	Point Value
Recent Major Bleeding	2
Cr >1.2 mg/dL	1.5
Anemia	1.5
Malignancy history	1
Clinically-overt PE	1
Age >75	1

Risk Categories & Outcomes

Based on total points, patients are stratified into three groups: 2,654 patients (20%) scored 0 points (low risk); 9,645 (74%) scored 1–4 points (intermediate risk); and 758 (5.8%) scored more than 4 points (high risk).

The corresponding 30-day/3-month major bleeding incidence in the derivation sample was: 0.3% in the low-risk group, 2.6% in the intermediate-risk group, and 7.3% in the high-risk group. In the validation sample, rates were 0.1%, 2.8%, and 6.2%, respectively — confirming the score's reliability across cohorts.

Results

Total Points	Major Bleeding (%)	Risk Level
0	0.1	Low
1-4	2.8	Intermediate
>4	6.2	High

Context and Later Comparisons

The RIETE score remains one of the more established bleeding-risk tools in VTE/PE, though newer scores have since been developed and compared against it:

VTE-BLEED — designed for stable, long-term anticoagulated patients, and described as the most validated risk score in VTE settings for major bleeding events across current oral anticoagulant classes. A comparison study found the RIETE and VTE-BLEED scores performed similarly (AUC 0.69–0.72), though the proportion of patients classified as high-risk differed markedly between the two — 7.1% with RIETE versus 62.3% with VTE-BLEED.
BACS score — developed specifically for PE patients receiving thrombolysis, using recent major bleeding, age >75, active cancer, and syncope; in that population, low-risk patients under RIETE and Kuijer scores still had 30-day major bleeding rates of 4.4% and 5.3% respectively, prompting the search for more refined tools.
PE-SARD score — a newer model using syncope, anemia, and renal dysfunction, also benchmarked directly against RIETE for predicting early major bleeding in acute PE.

Practical note: The RIETE score is intended to support clinical judgment about anticoagulation decisions, not replace it. If you're applying this to a specific patient or treatment decision, it's worth cross-checking against your institution's current guidelines, since several updated scores (VTE-BLEED, BACS, PE-SARD) have been proposed to improve on RIETE's discrimination in certain populations.

所有问题及可能的结果

Patient Details标题不可见

Recent major bleeding

Major bleeding in the derivation study was defined as overt bleeding plus ≥1 of the following:
- Requirement for transfusion of ≥2 units of blood.
- Retroperitoneal, spinal, or intracranial bleeding.
- Fatal bleeding.

Select one option:

Creatinine >1.2 mg/dL (106 μmol/L)

Select one option:

Anemia

Hgb <13 g/dL in men
Hgb <12 g/dL in women

Select one option:

Malignancy history

Select one option:

Clinically overt pulmonary embolism

Patients who were evaluated for PE and PE diagnosed, NOT incidental PE found during other studies

Select one option:

Age >75 years

Select one option:

可能的结果

Low Risk: Initiation of anticoagulation reasonable with monitoring

0.1% risk of major bleeding
Risk and benefits of anti-coagulation should be considered in patients, to include informed consent, prior to initiating therapy.
Clinical judgement and standard of care supersedes adjunct standalone decision tools.
Closely monitor and reassess bleeding risk during therapy. The model only captures baseline risk and does not account for interval clinical changes, such as new renal or hepatic dysfunction.
2019 European Society of Cardiology/European Respiratory Society PE guidelines

Intermediate Risk: Carefully consider risks and benefits of anticoagulation prior to starting therapy

2.8% risk of major bleeding
Risk and benefits of anti-coagulation should be considered in patients, to include informed consent, prior to initiating therapy.
Clinical judgement and standard of care supersedes adjunct standalone decision tools.
Closely monitor and reassess bleeding risk during therapy. The model only captures baseline risk and does not account for interval clinical changes, such as new renal or hepatic dysfunction.
2019 European Society of Cardiology/European Respiratory Society PE guidelines

High Risk: Alternative options should be considered unless there is a strong demonstrable clinical need for anticoagulation

6.2% risk of major bleeding
Risk and benefits of anti-coagulation should be considered in patients, to include informed consent, prior to initiating therapy.
Clinical judgement and standard of care supersedes adjunct standalone decision tools.
Closely monitor and reassess bleeding risk during therapy. The model only captures baseline risk and does not account for interval clinical changes, such as new renal or hepatic dysfunction.
2019 European Society of Cardiology/European Respiratory Society PE guidelines

引用

Ruíz-Giménez N, Suárez C, González R, Nieto JA, Todolí JA, Samperiz AL, Monreal M; RIETE Investigators. Predictive variables for major bleeding events in patients presenting with documented acute venous thromboembolism. Findings from the RIETE Registry. Thromb Haemost. 2008 Jul;100(1):26-31.

文献

Ruíz-Giménez N, Suárez C, González R, Nieto JA, Todolí JA, Samperiz AL, Monreal M; RIETE Investigators. Predictive variables for major bleeding events in patients presenting with documented acute venous thromboembolism. Findings from the RIETE Registry. Thromb Haemost. 2008 Jul;100(1):26-31.
https://pubmed.ncbi.nlm.nih.gov/18612534/
Guijarro R, Montes J, Sanromán C, et al. Venous thromboembolism in Spain. Comparison between an administrative database and the RIETE registry European Journal of Internal Medicine, 2008; 19, 443-446
https://www.ejinme.com/article/S0953-6205(08)00032-0/abstract
Scherz N, Méan M, Limacher A, Righini M, Jaeger K, Beer H-J, Frauchiger B, Osterwalder J, Kucher N, Matter CM, Banyai M, Angelillo-Scherrer A, Lämmle B, Husmann M, Egloff M, Aschwanden M, Bounameaux H, Cornuz J, Rodondi N, Aujesky D. Prospective, multicenter validation of prediction scores for major bleeding in elderly patients with venous thromboembolism. J Thromb Haemost 2012; 11: 435–43.
https://onlinelibrary.wiley.com/doi/full/10.1111/jth.12111
de Winter MA, van Es N, Büller HR, Visseren FLJ, Nijkeuter M. Prediction models for recurrence and bleeding in patients with venous thromboembolism: A systematic review and critical appraisal. Thromb Res. 2021 Mar; 199:85-96.
https://pubmed.ncbi.nlm.nih.gov/33485094/
Lecumberri R, Jiménez L, Ruiz-Artacho P, Nieto JA, Ruiz-Giménez N, Visonà A, Skride A, Moustafa F, Trujillo J, Monreal M; RIETE investigators. Prediction of Major Bleeding in Anticoagulated Patients for Venous Thromboembolism: Comparison of the RIETE and the VTE-BLEED Scores. TH Open. 2021 Aug 9;5(3):e319-e328.
https://pmc.ncbi.nlm.nih.gov/articles/PMC8459175/
Guman NAM, Becking AL, Weijers SS, Kraaijpoel N, Mulder FI, Carrier M, Jara-Palomares L, Di Nisio M, Ageno W, Beyer-Westendorf J, Klok FA, Vanassche T, Otten JMMB, Cosmi B, Peters MJL, Wolde MT, Delluc A, Sanchez-Lopez V, Porreca E, Bossuyt PMM, Gerdes VEA, Büller HR, van Es N, Kamphuisen PW. Risk assessment tools for bleeding in patients with unprovoked venous thromboembolism: an analysis of the PLATO-VTE study. J Thromb Haemost. 2024 Sep;22(9):2470-2481.
https://pubmed.ncbi.nlm.nih.gov/38866248/
Tao Y, Chen H, Dong C, Zhang J, Shi Y, Xu X, Wang M, Zhu L, Shi J, Ji Y, Chen H, Cheng Z, Tang Y, Li Y, Deng C, Luo Q, Lu P, Yang Y, Xi L, Zhang Y, Liang R, Wang D, Fan G, Xie W, Wan J, Zhang Z, Zhang S, Zhang Y, Huang Q, Gao Q, Liu M, Yang P, Wang S, Wang C, Zhai Z; CURES investigators. Performance of Bleeding Risk Scores for Major Bleeding in Anticoagulated Patients with Pulmonary Embolism: Insights from the CURES Registry-2. Thromb Haemost. 2026 May;126(5):496-508.
https://pubmed.ncbi.nlm.nih.gov/40555360/
Stavros V Konstantinides, Guy Meyer, Cecilia Becattini, Héctor Bueno, Geert-Jan Geersing, Veli-Pekka Harjola, Menno V Huisman, Marc Humbert, Catriona Sian Jennings, David Jiménez, Nils Kucher, Irene Marthe Lang, Mareike Lankeit, Roberto Lorusso, Lucia Mazzolai, Nicolas Meneveau, Fionnuala Ní Áinle, Paolo Prandoni, Piotr Pruszczyk, Marc Righini, Adam Torbicki, Eric Van Belle, José Luis Zamorano, ESC Scientific Document Group , 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC), European Heart Journal, Volume 41, Issue 4, 21 January 2020, Pages 543–603.
https://academic.oup.com/eurheartj/article/41/4/543/5556136?login=false

所有问题及可能的结果

引用

文献

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