AUTHOR=Fu Xiaoxue , Ren Huiya , Yang Yingbo , Niu Zhixue , Zhang Linjie 

TITLE=Analysis of influencing factors and construction of predictive model for major gastrointestinal bleeding after receiving VTE prophylactic anticoagulants in non-tumor patients

JOURNAL=Frontiers in Medicine

VOLUME=Volume 12 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2025.1618626

DOI=10.3389/fmed.2025.1618626

ISSN=2296-858X

ABSTRACT=ObjectiveThis study explored the factors associated with major gastrointestinal bleeding (MGB) after the use of prophylactic anticoagulants in patients with high risk of venous thromboembolism (VTE) and developed a predictive model to more accurately identify patients at high risk of MGB.MethodsWe collected related data on patients with a high risk of VTE and a low risk of bleeding between January 2020 and December 2024. Propensity score matching (PSM) was conducted to balance the important factors related to the disease status between the non-MGB and MGB groups. By applying univariate and multivariable logistic regression, predictive factors were refined to construct the nomogram. The prediction accuracy of the model was assessed through bootstrapping method (1,000 bootstrap samples), Hosmer-Lemeshow test, and calibration curve analysis. Decision curve analysis (DCA) was also used to assess the clinical applicability of the model.ResultsIn total, 1,206 eligible patients (1,060 non-MGB vs. 146 MGB) were included. After PSM, the non-MGB group (n = 146) and the MGB group (n = 146) were more balanced in baseline variables. The results of the multivariable analysis showed that hemoglobin level (OR = 0.883, 95% CI: 0.855–0.911, p < 0.001), albumin level (OR = 0.834, 95%CI: 0.754–0.922, p < 0.001) and use of proton-pump inhibitors (PPIs) or H2-receptor antagonists (H2RAs) (OR = 0.375, 95%CI: 0.167–0.843, p = 0.018) were associated with a reduced risk of MGB. The congruence of the model’s predictions with actual findings was confirmed by the calibration curve. Furthermore, DCA affirmed the clinical value of the model in predicting MGB.ConclusionThe addition of anemia and hypoproteinemia to the Improve-Bleed risk assessment model may help the timely and accurate screening of patients at high risk of MGB. The use of PPIs or H2RAs was associated with a reduced risk of MGB in patients receiving prophylactic anticoagulants for VTE.