AIMS65 Could Predict Treated Gastrointestinal Bleed Death, Rebleed Risks

Brooks D. Cash, MD

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Novel upper gastrointestinal bleeding risk stratification score AIMS65 may be a very useful index for identifying patients with a higher risk of mortality and rebleeding when using factor Xa inhibitors for the treatment of gastrointestinal bleeding, according to new data.

Research presented during the late-breaking sessions at the American College of Gastroenterology (ACG) 2024 Scientific Sessions in Philadelphia, PA, this weekend helps to validate AIMS65 as a risk grade tool for factor Xa inhibitor-related risk of severe bleeding outcomes. The findings may provide more prescriber confidence in utilizing the scoring metric for potential high-risk gastrointestinal bleeding patients.

The research team led by Brooks D. Cash, MD, of the University of Texas Health Science Center in Houston, sought to provide the first clinical characterization of mortality or rebleeding risk in patients receiving factor Xa inhibitor reversal via the AIMS65 score. Clinicians have previously touted the capability of AIMS65 as a risk factor indicator.

“Although AIMS65 needs to be further validated, it has the advantages of simplicity and lack of subjectivity compared to existing scoring systems,” Boyapati et al wrote. “It has been recently validated for in-hospital mortality, 30 and 90 day mortality and compared favorably to the (Glasgow Blatchford Score) for in-hospital mortality.”

Indeed, Cash and colleagues noted the AIMS65 score “has not been well-studied” for predicting mortality or rebleeding risks in patients with upper, lower, or unspecified gastrointestinal bleeds receiving an anticoagulant.

“This is the first study to characterize the likelihood of mortality or rebleeding using the AIMS65 score in patients receiving factor Xa inhibitor reversal,” the team noted.

The investigators conduced a retrospective cohort analysis of US adults hospitalized due to factor Xa inhibitor-linked gastrointestinal bleeding. Eligible patients were treated with andexant alfa (AA) or 4-factor prothrombin complex concentrate (4F-PCC) anticoagulant reversal; they additionally had to have received apixaban or rivaroxaban prior to hospital admission.

The team calculated AIMS65 scores during hospitalization after anticoagulant reversal, then correlated the scores with risk of rebleeding and death.

The assessment included 1860 medical records from 409 hospitals. Median patient age was 67.0 years old (IQR, 56 – 76). Two-thirds (63.0%) of patients were male; 71.8% were receiving apixaban, and 54% received a 4F-PCC reversal versus AA reversal. Another 50.8% were presented with impaired mental status.

Mean AIMS65 score was 1.8 on a 0 – 5 scale. The most common patient comorbidities were atrial fibrillation, hypertension, and diabetes—each prevalent in approximately 4 -5 in every 10 patients. One in 5 patients had a previous history of gastrointestinal bleeding.

The breakdown of gastrointestinal bleeding sites were 44.0% upper, 37.8% lower, 15.4% unspecified, and 2.6% multiple sites. Approximately 1 in 8 patients received vasopressors prior to anticoagulant reversal.

Cash and colleagues observed a positive correlation between increasing AIMS65 score and patient risk of death or rebleeding. The c-index was 0.87 for patient death (95% CI, 0.84 – 0.90) and 0.76 for rebleeding (95% CI, 0.71 – 0.81).

Patients with AIMS65 scores of ≥3 reported a 24.1% rate of death and 14.4% of rebleeds, versus rates of 1.6% and 2.1% among those with scores of <3, respectively. The odds ratios (ORs) were significantly greater for both outcomes based on AIMS65 scores—19.4 for death (95% CI, 12.4 – 31.7) and 7.8 for rebleeds (95% CI, 5.0 – 12.4).

“In patients undergoing factor Xa inhibitor reversal for GI bleeding, the AIM65 score was useful for identifying patients with a high likelihood of mortality and rebleeding, particularly for scores >3,” investigators concluded.

References

1. ^{Cash BD, Baugh CW, Coleman CI, Chang RC, et al. AIM65 as an Indicator of Rebleed and Mortality Risk in Patients Using Factor Xa Inhibitors Hospitalized for a Gastrointestinal (GI) Bleed. Abstract presented at: American College of Gastroenterology (ACG) 2024 Scientific Sessions. Philadelphia, PA. October 25 – 30, 2024.}
2. ^{Boyapati R, Majumdar A, Robertson M. AIMS65: a promising upper gastrointestinal bleeding risk score but further validation required. World J Gastroenterol. 2014 Oct 21;20(39):14515-6. doi: 10.3748/wjg.v20.i39.14515. PMID: 25339841; PMCID: PMC4202383.}