{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T15:46:03Z","timestamp":1762875963415},"reference-count":32,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2018,3]]},"abstract":"\n Background and Purpose\u2014<\/jats:title>\n \n The S\n 2<\/jats:sub>\n TOP-BLEED score may help to identify patients at high risk of bleeding on antiplatelet drugs after a transient ischemic attack or ischemic stroke. The score was derived on trial populations, and its performance in a real-world setting is unknown. We aimed to externally validate the S\n 2<\/jats:sub>\n TOP-BLEED score for major bleeding in a population-based cohort and to compare its performance with other risk scores for bleeding.\n <\/jats:p>\n <\/jats:sec>\n \n Methods\u2014<\/jats:title>\n \n We studied risk of bleeding in 2072 patients with a transient ischemic attack or ischemic stroke on antiplatelet agents in the population-based OXVASC (Oxford Vascular Study) according to 3 scores: S\n 2<\/jats:sub>\n TOP-BLEED, REACH, and Intracranial-B\n 2<\/jats:sub>\n LEED\n 3<\/jats:sub>\n S. Performance was assessed with C statistics and calibration plots.\n <\/jats:p>\n <\/jats:sec>\n \n Results\u2014<\/jats:title>\n \n During 8302 patient-years of follow-up, 117 patients had a major bleed. The S\n 2<\/jats:sub>\n TOP-BLEED score showed a C statistic of 0.69 (95% confidence interval [CI], 0.64\u20130.73) and accurate calibration for 3-year risk of major bleeding. The S\n 2<\/jats:sub>\n TOP-BLEED score was much more predictive of fatal bleeding than nonmajor bleeding (C statistics 0.77; 95% CI, 0.69\u20130.85 and 0.50; 95% CI, 0.44\u20130.58). The REACH score had a C statistic of 0.63 (95% CI, 0.58\u20130.69) for major bleeding and the Intracranial-B\n 2<\/jats:sub>\n LEED\n 3<\/jats:sub>\n S score a C statistic of 0.60 (95% CI, 0.51\u20130.70) for intracranial bleeding. The ratio of ischemic events versus bleeds decreased across risk groups of bleeding from 6.6:1 in the low-risk group to 1.8:1 in the high-risk group.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions\u2014<\/jats:title>\n \n The S\n 2<\/jats:sub>\n TOP-BLEED score shows modest performance in a population-based cohort of patients with a transient ischemic attack or ischemic stroke. Although bleeding risks were associated with risks of ischemic events, risk stratification may still be useful to identify a subgroup of patients at particularly high risk of bleeding, in whom preventive measures are indicated.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/strokeaha.117.019259","type":"journal-article","created":{"date-parts":[[2018,2,19]],"date-time":"2018-02-19T10:05:13Z","timestamp":1519034713000},"page":"601-606","update-policy":"http:\/\/dx.doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["External Validation of Risk Scores for Major Bleeding in a Population-Based Cohort of Transient Ischemic Attack and Ischemic Stroke Patients"],"prefix":"10.1161","volume":"49","author":[{"given":"Nina A.","family":"Hilkens","sequence":"first","affiliation":[{"name":"From the Julius Center for Health Sciences and Primary Care (N.A.H., A.A., J.P.G.) and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (A.A.), University Medical Center Utrecht, Utrecht University, the Netherlands; and Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom (L.L., P.M.R.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linxin","family":"Li","sequence":"additional","affiliation":[{"name":"From the Julius Center for Health Sciences and Primary Care (N.A.H., A.A., J.P.G.) and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (A.A.), University Medical Center Utrecht, Utrecht University, the Netherlands; and Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom (L.L., P.M.R.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter M.","family":"Rothwell","sequence":"additional","affiliation":[{"name":"From the Julius Center for Health Sciences and Primary Care (N.A.H., A.A., J.P.G.) and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (A.A.), University Medical Center Utrecht, Utrecht University, the Netherlands; and Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom (L.L., P.M.R.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ale","family":"Algra","sequence":"additional","affiliation":[{"name":"From the Julius Center for Health Sciences and Primary Care (N.A.H., A.A., J.P.G.) and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (A.A.), University Medical Center Utrecht, Utrecht University, the Netherlands; and Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom (L.L., P.M.R.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacoba P.","family":"Greving","sequence":"additional","affiliation":[{"name":"From the Julius Center for Health Sciences and Primary Care (N.A.H., A.A., J.P.G.) and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (A.A.), University Medical Center Utrecht, Utrecht University, the Netherlands; and Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom (L.L., P.M.R.)."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0000000000000024"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)60503-1"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1747-4949.2011.00718.x"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)61751-7"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)30770-5"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000004289"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(96)09457-3"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-510X(96)00308-5"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(04)16721-4"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa060989"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(06)68734-5"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0805002"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)60600-4"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001744"},{"key":"e_1_3_4_16_2","volume-title":"Clinical Prediction Models, A Practical Approach to Development, Validation and Updating","author":"Steyerberg EW","year":"2009","unstructured":"Steyerberg EW. 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