Recurrent venous thromboembolism and bleeding with extended anticoagulation: the VTE-PREDICT risk score
AIMS: Deciding to stop or continue anticoagulation for venous thromboembolism (VTE) after initial treatment is challenging, as individual risks of recurrence and bleeding are heterogeneous. The present study aimed to develop and externally validate models for predicting 5-year risks of recurrence an...
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Online Access: | http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10079391/ http://www.ncbi.nlm.nih.gov/pubmed/36648242 https://doi.org/10.1093/eurheartj/ehac776 |
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ftpubmed:oai:pubmedcentral.nih.gov:10079391 2023-05-15T18:34:47+02:00 Recurrent venous thromboembolism and bleeding with extended anticoagulation: the VTE-PREDICT risk score de Winter, Maria A Büller, Harry R Carrier, Marc Cohen, Alexander T Hansen, John-Bjarne Kaasjager, Karin A H Kakkar, Ajay K Middeldorp, Saskia Raskob, Gary E Sørensen, Henrik T Visseren, Frank L J Wells, Philip S Dorresteijn, Jannick A N Nijkeuter, Mathilde 2023-01-17 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10079391/ http://www.ncbi.nlm.nih.gov/pubmed/36648242 https://doi.org/10.1093/eurheartj/ehac776 en eng Oxford University Press http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10079391/ http://www.ncbi.nlm.nih.gov/pubmed/36648242 http://dx.doi.org/10.1093/eurheartj/ehac776 © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com Eur Heart J Clinical Research Text 2023 ftpubmed https://doi.org/10.1093/eurheartj/ehac776 2023-04-09T01:10:20Z AIMS: Deciding to stop or continue anticoagulation for venous thromboembolism (VTE) after initial treatment is challenging, as individual risks of recurrence and bleeding are heterogeneous. The present study aimed to develop and externally validate models for predicting 5-year risks of recurrence and bleeding in patients with VTE without cancer who completed at least 3 months of initial treatment, which can be used to estimate individual absolute benefits and harms of extended anticoagulation. METHODS AND RESULTS: Competing risk-adjusted models were derived to predict recurrent VTE and clinically relevant bleeding (non-major and major) using 14 readily available patient characteristics. The models were derived from combined individual patient data from the Bleeding Risk Study, Hokusai-VTE, PREFER-VTE, RE-MEDY, and RE-SONATE (n = 15,141, 220 recurrences, 189 bleeding events). External validity was assessed in the Danish VTE cohort, EINSTEIN-CHOICE, GARFIELD-VTE, MEGA, and Tromsø studies (n = 59 257, 2283 recurrences, 3335 bleeding events). Absolute treatment effects were estimated by combining the models with hazard ratios from trials and meta-analyses. External validation in different settings showed agreement between predicted and observed risks up to 5 years, with C-statistics ranging from 0.48–0.71 (recurrence) and 0.61–0.68 (bleeding). In the Danish VTE cohort, 5-year risks ranged from 4% to 19% for recurrent VTE and 1% –19% for bleeding. CONCLUSION: The VTE-PREDICT risk score can be applied to estimate the effect of extended anticoagulant treatment for individual patients with VTE and to support shared decision-making. Text Tromsø PubMed Central (PMC) Tromsø European Heart Journal 44 14 1231 1244 |
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Clinical Research |
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Clinical Research de Winter, Maria A Büller, Harry R Carrier, Marc Cohen, Alexander T Hansen, John-Bjarne Kaasjager, Karin A H Kakkar, Ajay K Middeldorp, Saskia Raskob, Gary E Sørensen, Henrik T Visseren, Frank L J Wells, Philip S Dorresteijn, Jannick A N Nijkeuter, Mathilde Recurrent venous thromboembolism and bleeding with extended anticoagulation: the VTE-PREDICT risk score |
topic_facet |
Clinical Research |
description |
AIMS: Deciding to stop or continue anticoagulation for venous thromboembolism (VTE) after initial treatment is challenging, as individual risks of recurrence and bleeding are heterogeneous. The present study aimed to develop and externally validate models for predicting 5-year risks of recurrence and bleeding in patients with VTE without cancer who completed at least 3 months of initial treatment, which can be used to estimate individual absolute benefits and harms of extended anticoagulation. METHODS AND RESULTS: Competing risk-adjusted models were derived to predict recurrent VTE and clinically relevant bleeding (non-major and major) using 14 readily available patient characteristics. The models were derived from combined individual patient data from the Bleeding Risk Study, Hokusai-VTE, PREFER-VTE, RE-MEDY, and RE-SONATE (n = 15,141, 220 recurrences, 189 bleeding events). External validity was assessed in the Danish VTE cohort, EINSTEIN-CHOICE, GARFIELD-VTE, MEGA, and Tromsø studies (n = 59 257, 2283 recurrences, 3335 bleeding events). Absolute treatment effects were estimated by combining the models with hazard ratios from trials and meta-analyses. External validation in different settings showed agreement between predicted and observed risks up to 5 years, with C-statistics ranging from 0.48–0.71 (recurrence) and 0.61–0.68 (bleeding). In the Danish VTE cohort, 5-year risks ranged from 4% to 19% for recurrent VTE and 1% –19% for bleeding. CONCLUSION: The VTE-PREDICT risk score can be applied to estimate the effect of extended anticoagulant treatment for individual patients with VTE and to support shared decision-making. |
format |
Text |
author |
de Winter, Maria A Büller, Harry R Carrier, Marc Cohen, Alexander T Hansen, John-Bjarne Kaasjager, Karin A H Kakkar, Ajay K Middeldorp, Saskia Raskob, Gary E Sørensen, Henrik T Visseren, Frank L J Wells, Philip S Dorresteijn, Jannick A N Nijkeuter, Mathilde |
author_facet |
de Winter, Maria A Büller, Harry R Carrier, Marc Cohen, Alexander T Hansen, John-Bjarne Kaasjager, Karin A H Kakkar, Ajay K Middeldorp, Saskia Raskob, Gary E Sørensen, Henrik T Visseren, Frank L J Wells, Philip S Dorresteijn, Jannick A N Nijkeuter, Mathilde |
author_sort |
de Winter, Maria A |
title |
Recurrent venous thromboembolism and bleeding with extended anticoagulation: the VTE-PREDICT risk score |
title_short |
Recurrent venous thromboembolism and bleeding with extended anticoagulation: the VTE-PREDICT risk score |
title_full |
Recurrent venous thromboembolism and bleeding with extended anticoagulation: the VTE-PREDICT risk score |
title_fullStr |
Recurrent venous thromboembolism and bleeding with extended anticoagulation: the VTE-PREDICT risk score |
title_full_unstemmed |
Recurrent venous thromboembolism and bleeding with extended anticoagulation: the VTE-PREDICT risk score |
title_sort |
recurrent venous thromboembolism and bleeding with extended anticoagulation: the vte-predict risk score |
publisher |
Oxford University Press |
publishDate |
2023 |
url |
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10079391/ http://www.ncbi.nlm.nih.gov/pubmed/36648242 https://doi.org/10.1093/eurheartj/ehac776 |
geographic |
Tromsø |
geographic_facet |
Tromsø |
genre |
Tromsø |
genre_facet |
Tromsø |
op_source |
Eur Heart J |
op_relation |
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10079391/ http://www.ncbi.nlm.nih.gov/pubmed/36648242 http://dx.doi.org/10.1093/eurheartj/ehac776 |
op_rights |
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
op_doi |
https://doi.org/10.1093/eurheartj/ehac776 |
container_title |
European Heart Journal |
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44 |
container_issue |
14 |
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1231 |
op_container_end_page |
1244 |
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1766219693909082112 |