TY - JOUR
T1 - Development of Sex-Stratified Prediction Models for Recurrent Venous Thromboembolism
T2 - A Danish Nationwide Cohort Study
AU - Albertsen, Ida Ehlers
AU - Søgaard, Mette
AU - Goldhaber, Samuel Zachary
AU - Piazza, Gregory
AU - Skjøth, Flemming
AU - Overvad, Thure Filskov
AU - Larsen, Torben Bjerregaard
AU - Nielsen, Peter Brønnum
N1 - Georg Thieme Verlag KG Stuttgart · New York.
PY - 2020/5
Y1 - 2020/5
N2 - OBJECTIVE: To optimize decision making for anticoagulant treatment duration after incident venous thromboembolism, we derived and internally validated two clinically applicable sex-specific prediction models for venous thromboembolism recurrence, discarding the traditional categorization of provoked and unprovoked venous thromboembolism.METHODS: This study was based on data from Danish nationwide registries. We identified all routine care in- and outpatients with completed anticoagulant treatment for incident venous thromboembolism from 2012 through 2017. The outcome was recurrent venous thromboembolism within 2 years. Risk scores were derived using Cox regression analysis and a backward selection process on a set of 24 potential predictors. Performance was assessed through calibration and discrimination using bootstrap techniques to internally validate the scores.RESULTS: The study included 11,519 patients. Risk scores under the joint acronym AIM-SHA-RP were developed. Age, Incident pulmonary embolism, and recent Major surgery were predictors for both sexes; Statin treatment, Heart disease and Antiplatelet treatment were predictors specifically for men, while chronic Renal disease and recent Pneumonia or sepsis were predictors specifically for women. The risk scores were well calibrated and identified a low- (< 5%), intermediate- (5-10%), and high-risk (> 10%) group for both sexes. Generally, discriminative capacities, as measured by the c-statistic, were limited.CONCLUSION: We developed two clinically applicable risk scores to estimate the risk of recurrent venous thromboembolism after completed anticoagulant treatment. The risk scores can potentially guide treatment duration of anticoagulation after incident venous thromboembolism but require further external validation before implemented in clinical practice.
AB - OBJECTIVE: To optimize decision making for anticoagulant treatment duration after incident venous thromboembolism, we derived and internally validated two clinically applicable sex-specific prediction models for venous thromboembolism recurrence, discarding the traditional categorization of provoked and unprovoked venous thromboembolism.METHODS: This study was based on data from Danish nationwide registries. We identified all routine care in- and outpatients with completed anticoagulant treatment for incident venous thromboembolism from 2012 through 2017. The outcome was recurrent venous thromboembolism within 2 years. Risk scores were derived using Cox regression analysis and a backward selection process on a set of 24 potential predictors. Performance was assessed through calibration and discrimination using bootstrap techniques to internally validate the scores.RESULTS: The study included 11,519 patients. Risk scores under the joint acronym AIM-SHA-RP were developed. Age, Incident pulmonary embolism, and recent Major surgery were predictors for both sexes; Statin treatment, Heart disease and Antiplatelet treatment were predictors specifically for men, while chronic Renal disease and recent Pneumonia or sepsis were predictors specifically for women. The risk scores were well calibrated and identified a low- (< 5%), intermediate- (5-10%), and high-risk (> 10%) group for both sexes. Generally, discriminative capacities, as measured by the c-statistic, were limited.CONCLUSION: We developed two clinically applicable risk scores to estimate the risk of recurrent venous thromboembolism after completed anticoagulant treatment. The risk scores can potentially guide treatment duration of anticoagulation after incident venous thromboembolism but require further external validation before implemented in clinical practice.
KW - Adult
KW - Aged
KW - Aged, 80 and over
KW - Anticoagulants/therapeutic use
KW - Clinical Decision-Making
KW - Decision Support Techniques
KW - Denmark/epidemiology
KW - Female
KW - Humans
KW - Incidence
KW - Male
KW - Middle Aged
KW - Predictive Value of Tests
KW - Recurrence
KW - Registries
KW - Reproducibility of Results
KW - Risk Assessment
KW - Risk Factors
KW - Sex Factors
KW - Time Factors
KW - Venous Thromboembolism/diagnosis
UR - http://www.scopus.com/inward/record.url?scp=85084277516&partnerID=8YFLogxK
U2 - 10.1055/s-0040-1708877
DO - 10.1055/s-0040-1708877
M3 - Journal article
C2 - 32369851
SN - 0340-6245
VL - 120
SP - 805
EP - 814
JO - Thrombosis and Haemostasis
JF - Thrombosis and Haemostasis
IS - 5
ER -