静脉血栓栓塞 (VTE) 抗凝治疗期间颅内出血的风险很大，并且在初始治疗阶段后仍持续存在。我们的目标是通过特定阶段的预后评分来完善风险评估。我们识别了 2009 年 3 月至 2023 年 10 月 RIETE 登记中 77,786 名 VTE 患者的数据，以制定两种颅内出血预后评分。使用多变量 Cox 回归分析早期（≤90 天）和晚期（>90 天）阶段的不同变量，并与现有评分（改良的 ACCP、RIETE、VTE-BLEED 和 CHAP）进行比较验证。颅内出血发生在411 例患者（0.53%），其中早期 208 例，晚期 203 例。 30 天死亡率分别为 45% 和 35%。这两个阶段的共同重要预测因素包括基线异常精神状态、脑癌、近期颅内出血和癫痫。早期出血的独特之处在于体重、非脑癌、高血压、痴呆、血小板减少、肾功能不全和溶栓治疗。高龄、最初患有肺栓塞、既往中风、抑郁症、直接口服抗凝剂治疗以及皮质类固醇的使用可预测晚期出血。两个预后评分的 c 统计值为 0.68，优于现有评分。该研究引入了 VTE 抗凝期间颅内出血的两个时间预后评分。通过识别与每个治疗阶段相关的特定风险因素，这些评分优于传统模型，为临床决策提供了先进的工具。它们在优化抗凝管理和降低出血相关死亡率方面具有巨大潜力。版权所有 © 2024。由 Elsevier Ltd 出版。

The risk of intracranial bleeding during anticoagulation for venous thromboembolism (VTE) is substantial and persists beyond the initial treatment phase. We aimed to refine risk-assessment through phase-specific prognostic scores.We identified data from 77,786 VTE patients in the RIETE registry from March 2009 to October 2023 to develop two prognostic scores for intracranial bleeding. Multivariable Cox regression was used to analyze distinct variables for the early (≤90 days) and late (>90 days) phases, with comparative validation against existing scores (modified ACCP, RIETE, VTE-BLEED, and CHAP).Intracranial bleeding occurred in 411 patients (0.53 %), with 208 cases in the early phase and 203 in the late phase. The 30-day mortality was 45 % and 35 %, respectively. Shared significant predictors for both phases include baseline abnormal mental status, brain cancer, recent intracranial bleeding, and epilepsy. Unique to early-phase bleeding were body weight, non-brain cancer, hypertension, dementia, thrombocytopenia, renal insufficiency, and thrombolytic therapy. Advanced age, pulmonary embolism initially, prior stroke, depression, treatment with direct oral anticoagulants, and use of corticosteroids predicted late-phase bleeding. Both prognostic scores showed a c-statistic of 0.68, outperforming existing scores.The study introduces two temporal prognostic scores for intracranial bleeding during anticoagulation for VTE. By discerning specific risk factors pertinent to each treatment phase, these scores outperform traditional models, offering an advanced tool for clinical decision-making. They hold significant potential for optimizing anticoagulation management and reducing bleeding-related mortality.Copyright © 2024. Published by Elsevier Ltd.