Article Impact Level: HIGH Data Quality: STRONG Summary of European Heart Journal, ehac776. https://doi.org/10.1093/eurheartj/ehac776 Dr. Maria de Winter et al
Points
- Forecasting bleeding and persistent venous thromboembolism have proven challenging after three to six months of anticoagulation.
- The usefulness of the venous thromboembolism risk assessment tools in promoting collaborative decision-making on the length of anticoagulation following acute venous thromboembolism might be restricted.
- The ability of the venous thromboembolism risk assessment models to forecast recurring venous thromboembolism and bleeding following secondary venous thromboembolism prophylaxis in external validation cohorts was only fair.
Summary
The study’s primary objective was to evaluate factors associated with chronic venous thromboembolism and hemorrhage in non-cancer individuals who had finished their first anticoagulation course lasting more than three months.
The researchers used easily accessible individual variables to run a competitive hazard model for every repeated venous thromboembolism and disease-related hemorrhage. They considered the processes’ major and minor outcomes from five earlier trials, including 15,141 participants, 220 with repeated thromboembolism episodes, and 189 with significant bleeding. In five additional investigations with 59,257 patients, 2,283 recurring venous thromboembolism episodes and 3,335 bleeding occurrences in external validation were evaluated. The type and dosage of antiplatelet drug usage were particular indicators.
Age, female gender, body mass index, a form of index incident, either pulmonary embolism or deep vein thrombosis, the existence of inciting possible risks, usage of estrogen medication, a record of cancer, and previous history of venous thromboembolism were all accounted for in the recurring venous thromboembolism estimation method.
Age, female gender, systolic blood pressure, cancer and hemorrhage history, previous cerebrovascular history, hemoglobin laboratory values, and simultaneous utilization of nonsteroidal anti-inflammatory drugs were all factors in the bleeding risk model. On identifying persistent venous thromboembolism and bleeding, the C-statistics in the external validation cohorts varied from 0.48 to 0.71 and 0.61 to 0.68, respectively. There were 5-year chances of venous thromboembolism ranging from 4–19% in the Danish venous thromboembolism group, whereas the 5-year risks of hemorrhage varied from 1–19%.
According to the researchers, the venous thromboembolism indicator can quantify the impact of prolonged anticoagulation therapy for specific venous thromboembolism individuals and assist collective decision-making.
Although anticoagulation should be administered for at least three to six months to all individuals suffering from acute venous thromboembolism, deciding whether to continue management beyond that point might be more difficult. Only a few past recurring venous thromboembolism risk assessment tools have received external validation.
Creating a reliable hemorrhage risk rating for venous thromboembolism individuals has proven more difficult. This study aimed to advance on both aspects using the same clinical components seen in earlier ratings. However, the venous thromboembolism risk prediction score’s average categorization capability is weak to moderate in the external validation groups, which restricted its capacity to be conclusive. Nevertheless, after the early three to six months acute treatment period, it played a valuable role for patients and physicians as they participated in collective decision-making concerning secondary venous thromboembolism avoidance.
Link to the article: https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.061025
References De Winter, M. A., Büller, H. R., Carrier, M., Cohen, A. T., Hansen, J.-B., Kaasjager, K. A. H., Kakkar, A. K., Middeldorp, S., Raskob, G. E., Sørensen, H. T., Visseren, F. L. J., Wells, P. S., Dorresteijn, J. A. N., Nijkeuter, M., VTE-PREDICT study group, Braekkan, S. K., Burggraaf, L., Cannegieter, S. C., Farjat, A., … Virdone, S. (2023). Recurrent venous thromboembolism and bleeding with extended anticoagulation: The VTE-PREDICT risk score. European Heart Journal, ehac776. https://doi.org/10.1093/eurheartj/ehac776
