Thromb Haemost 2020; 120(05): 805-814
DOI: 10.1055/s-0040-1708877
Stroke, Systemic or Venous Thromboembolism
Georg Thieme Verlag KG Stuttgart · New York

Development of Sex-Stratified Prediction Models for Recurrent Venous Thromboembolism: A Danish Nationwide Cohort Study

1  Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
2  Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
,
Mette Søgaard
1  Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
2  Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
,
Samuel Zachary Goldhaber
3  Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
Gregory Piazza
3  Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
Flemming Skjøth
2  Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
4  Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
,
2  Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
,
Torben Bjerregaard Larsen
1  Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
2  Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
,
Peter Brønnum Nielsen
1  Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
2  Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
› Author Affiliations
Funding The Obel Family Foundation partly funded this research by an unrestricted grant. The sponsor had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; in the writing of the report; and in the decision to submit the paper for publication.
Further Information

Publication History

12 December 2019

13 February 2020

Publication Date:
05 May 2020 (online)

Abstract

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.

Supplementary Material