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 and...
Published in: | European Heart Journal |
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Oxford University Press
2023
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Online Access: | https://hdl.handle.net/10037/31970 https://doi.org/10.1093/eurheartj/ehac776 |
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ftunivtroemsoe:oai:munin.uit.no:10037/31970 2024-01-07T09:47:05+01:00 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 Brækkan, Sigrid Kufaas 2023-01-17 https://hdl.handle.net/10037/31970 https://doi.org/10.1093/eurheartj/ehac776 eng eng Oxford University Press European Heart Journal De Winter, Büller, Carrier, Cohen, Hansen, Kaasjager, Kakkar, Middeldorp, Raskob, Sørensen, Visseren, Wells, Dorresteijn, Nijkeuter, Brækkan. Recurrent venous thromboembolism and bleeding with extended anticoagulation: the VTE-PREDICT risk score. European Heart Journal. 2023;44(14):1231-1244 FRIDAID 2175909 doi:10.1093/eurheartj/ehac776 0195-668X 1522-9645 https://hdl.handle.net/10037/31970 Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) openAccess Copyright 2023 The Author(s) https://creativecommons.org/licenses/by-nc/4.0 Journal article Tidsskriftartikkel Peer reviewed publishedVersion 2023 ftunivtroemsoe https://doi.org/10.1093/eurheartj/ehac776 2023-12-14T00:08:06Z 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. Article in Journal/Newspaper Tromsø University of Tromsø: Munin Open Research Archive Tromsø European Heart Journal 44 14 1231 1244 |
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Open Polar |
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University of Tromsø: Munin Open Research Archive |
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ftunivtroemsoe |
language |
English |
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 |
Article in Journal/Newspaper |
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 Brækkan, Sigrid Kufaas |
spellingShingle |
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 Brækkan, Sigrid Kufaas Recurrent venous thromboembolism and bleeding with extended anticoagulation: the VTE-PREDICT risk score |
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 Brækkan, Sigrid Kufaas |
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 |
https://hdl.handle.net/10037/31970 https://doi.org/10.1093/eurheartj/ehac776 |
geographic |
Tromsø |
geographic_facet |
Tromsø |
genre |
Tromsø |
genre_facet |
Tromsø |
op_relation |
European Heart Journal De Winter, Büller, Carrier, Cohen, Hansen, Kaasjager, Kakkar, Middeldorp, Raskob, Sørensen, Visseren, Wells, Dorresteijn, Nijkeuter, Brækkan. Recurrent venous thromboembolism and bleeding with extended anticoagulation: the VTE-PREDICT risk score. European Heart Journal. 2023;44(14):1231-1244 FRIDAID 2175909 doi:10.1093/eurheartj/ehac776 0195-668X 1522-9645 https://hdl.handle.net/10037/31970 |
op_rights |
Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) openAccess Copyright 2023 The Author(s) https://creativecommons.org/licenses/by-nc/4.0 |
op_doi |
https://doi.org/10.1093/eurheartj/ehac776 |
container_title |
European Heart Journal |
container_volume |
44 |
container_issue |
14 |
container_start_page |
1231 |
op_container_end_page |
1244 |
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1787429048891211776 |