Clot Chronicles: PE-SARD – An Original Risk Score to Predict Bleeding in Acute PE

Hi, my name is Dr. Gregory Piazza, and I’m one of the vascular medicine cardiologists at Brigham and Women’s Hospital. I’m also a member of the Board of Directors of the North American Thrombosis Forum and the Education Chair. Today on Clot Chronicles, we’re going to be talking about a risk score for identifying patients at increased risk of major bleeding early in treatment for pulmonary embolism (PE). 

This study, published by a group in France, was called PE-SARD, and they asked a very important question, which is whether a simple scoring system could predict early major bleeding in patients with PE – and whether you could put patients into categories of high or low risk of early major bleeding.  

They used a 2800-patient, multicenter, prospective registry to assess this tool and did statistical analyses to generate and assess the ability of this tool to predict major bleeding. It’s called PE-SARD because it’s made up of a number of components. First of all, it’s for PE, and it takes into account syncope, anemia, and renal dysfunction. Each category gives a certain number of points. 

And using this system, they were able to divide their population of PE patients into patients with a score of 0 (low risk of bleeding, about 50% of the population), patients with a score of 1 to 2.5 points (the intermediate-risk population, about 35% of the population), and then high risk, which was greater than 2.5 points (almost 13% of the population). 

They were then able to observe bleeding rates of 0.9% in the low-risk group and up to 9% in the high-risk group. And so, the score was very good at distinguishing the risk of bleeding. Comparing it to other scores that have been used—VTE-BLEED, the RIETE score, or the BACS score—they found that PE-SARD was able to classify a higher proportion of patients into the higher risk category. 

In summary, the PE-SARD bleeding risk score was a user-friendly score only taking into account 3 major categories and was able to very nicely categorize patients into low-risk, intermediate risk, and high risk; the high-risk patients really did have an increase in the risk of hemorrhage with anticoagulation and PE. In the future, this kind of tool might help to advise clinicians on safer anticoagulation strategies or patients that might need to be monitored more carefully. 

Thank you very much, and I hope you enjoyed this discussion of PE-SARD.