Risk prediction of recurrent venous thrombosis; where are we now and what can we add?
Background Several models are available to predict recurrent venous thrombosis (VT) in patients with unprovoked first events. Objectives To validate these prediction models externally. Methods Within the MEGA follow‐up study (n = 3750), we externally validated the Vienna and DASH score. These models...
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| Veröffentlicht in: | Journal of thrombosis and haemostasis 2019-09, Vol.17 (9), p.1527-1534 |
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| creator | Timp, Jasmijn F. Lijfering, Willem M. Rosendaal, Frits R. Cessie, Saskia Cannegieter, Suzanne C. |
| description | Background
Several models are available to predict recurrent venous thrombosis (VT) in patients with unprovoked first events.
Objectives
To validate these prediction models externally.
Methods
Within the MEGA follow‐up study (n = 3750), we externally validated the Vienna and DASH score. These models were validated (a) by using the original study's criteria for patients with unprovoked VT and (b) by using our own criteria for unprovoked VT. In addition, absolute recurrence risks based on individual VT risk factors were calculated.
Results
The recurrence rate was 5.2 (95% CI, 4.6‐5.9) per 100 patient‐years in those who had a first unprovoked VT according to our definition. For the Vienna model it was 3.4 per 100 patient‐years and for DASH 3.8 per 100 patient‐years. The C‐statistic was 0.62 for Vienna and 0.65 for DASH. The C‐statistic declined to 0.58 for both Vienna and DASH when we used our own definition of “unprovoked VT.” Within the provoked group a strong gradient in risk was found dependent on the presence of traditional risk factors or biomarkers in a patient.
Conclusions
The ability to distinguish patients’ recurrence risks is lower than proposed in the original prediction model studies and dependent on the definition that is used for an unprovoked first event. Furthermore, our results suggest that a more‐refined risk estimation is possible, also in patients with a provoked first event, who are currently all classified as low risk. |
| doi_str_mv | 10.1111/jth.14535 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6851549</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2283325575</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4435-21e46abeaa8fef45ede73f5b4729012591c77068ddc98eb5d5816888366ffdb93</originalsourceid><addsrcrecordid>eNp1kV9LwzAUxYMobk4f_AIS8MmHbk3TtCmCIkOdMhBkew5pc-s6t2Ym7cq-van7gz4YCAk3P849NwehS-L3iVuDeTXrk5BRdoS6hFHuxZxGx_t7QmkHnVk7932SsMA_RR1KCOeMsC6avhf2E68MqCKrCl1inWMDWW0MlBVeQ6lri6uZ0ctU28Le4mYGBrB0uwFc6gbLUrmirHAmy7Ymlbo_Rye5XFi42J09NH16nAxH3vjt-WX4MPayMKTMCwiEkUxBSp5DHjJQENOcpWEcJD4JWEKyOPYjrlSWcEiZYpxEnLvhojxXaUJ76G6ru6rTJajMeTZyIVamWEqzEVoW4u9LWczEh16LqJ0-bAWudwJGf9VgKzHXtSmdZxEEnNKAsZg56mZLZUZbayA_dCC-aBMQLgHxk4Bjr35bOpD7L3fAYAs0xQI2_yuJ18loK_kNngWQ7Q</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2283325575</pqid></control><display><type>article</type><title>Risk prediction of recurrent venous thrombosis; where are we now and what can we add?</title><source>MEDLINE</source><source>Alma/SFX Local Collection</source><source>EZB Electronic Journals Library</source><creator>Timp, Jasmijn F. ; Lijfering, Willem M. ; Rosendaal, Frits R. ; Cessie, Saskia ; Cannegieter, Suzanne C.</creator><creatorcontrib>Timp, Jasmijn F. ; Lijfering, Willem M. ; Rosendaal, Frits R. ; Cessie, Saskia ; Cannegieter, Suzanne C.</creatorcontrib><description>Background
Several models are available to predict recurrent venous thrombosis (VT) in patients with unprovoked first events.
Objectives
To validate these prediction models externally.
Methods
Within the MEGA follow‐up study (n = 3750), we externally validated the Vienna and DASH score. These models were validated (a) by using the original study's criteria for patients with unprovoked VT and (b) by using our own criteria for unprovoked VT. In addition, absolute recurrence risks based on individual VT risk factors were calculated.
Results
The recurrence rate was 5.2 (95% CI, 4.6‐5.9) per 100 patient‐years in those who had a first unprovoked VT according to our definition. For the Vienna model it was 3.4 per 100 patient‐years and for DASH 3.8 per 100 patient‐years. The C‐statistic was 0.62 for Vienna and 0.65 for DASH. The C‐statistic declined to 0.58 for both Vienna and DASH when we used our own definition of “unprovoked VT.” Within the provoked group a strong gradient in risk was found dependent on the presence of traditional risk factors or biomarkers in a patient.
Conclusions
The ability to distinguish patients’ recurrence risks is lower than proposed in the original prediction model studies and dependent on the definition that is used for an unprovoked first event. Furthermore, our results suggest that a more‐refined risk estimation is possible, also in patients with a provoked first event, who are currently all classified as low risk.</description><identifier>ISSN: 1538-7933</identifier><identifier>ISSN: 1538-7836</identifier><identifier>EISSN: 1538-7836</identifier><identifier>DOI: 10.1111/jth.14535</identifier><identifier>PMID: 31188515</identifier><language>eng</language><publisher>England: Elsevier Limited</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anticoagulants - therapeutic use ; Area Under Curve ; Case-Control Studies ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Models, Biological ; Original ; Patients ; Practice Guidelines as Topic ; prediction ; Prediction models ; Prognosis ; Pulmonary Embolism - epidemiology ; Pulmonary Embolism - etiology ; Recurrence ; recurrent venous thrombosis ; Risk ; Risk factors ; ROC Curve ; Severity of Illness Index ; Thrombophilia - complications ; Thrombophilia - diagnosis ; Thrombophilia - drug therapy ; THROMBOSIS ; validation ; Validation Studies as Topic ; venous thrombosis ; Venous Thrombosis - blood ; Venous Thrombosis - drug therapy ; Venous Thrombosis - epidemiology ; Venous Thrombosis - etiology ; Young Adult</subject><ispartof>Journal of thrombosis and haemostasis, 2019-09, Vol.17 (9), p.1527-1534</ispartof><rights>2019 The Authors. published by Wiley Periodicals, Inc. on behalf of International Society on Thrombosis and Haemostasis</rights><rights>2019 The Authors. Journal of Thrombosis and Haemostasis published by Wiley Periodicals, Inc. on behalf of International Society on Thrombosis and Haemostasis.</rights><rights>Copyright © 2019 International Society on Thrombosis and Haemostasis</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4435-21e46abeaa8fef45ede73f5b4729012591c77068ddc98eb5d5816888366ffdb93</citedby><cites>FETCH-LOGICAL-c4435-21e46abeaa8fef45ede73f5b4729012591c77068ddc98eb5d5816888366ffdb93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,315,781,785,886,27929,27930</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31188515$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Timp, Jasmijn F.</creatorcontrib><creatorcontrib>Lijfering, Willem M.</creatorcontrib><creatorcontrib>Rosendaal, Frits R.</creatorcontrib><creatorcontrib>Cessie, Saskia</creatorcontrib><creatorcontrib>Cannegieter, Suzanne C.</creatorcontrib><title>Risk prediction of recurrent venous thrombosis; where are we now and what can we add?</title><title>Journal of thrombosis and haemostasis</title><addtitle>J Thromb Haemost</addtitle><description>Background
Several models are available to predict recurrent venous thrombosis (VT) in patients with unprovoked first events.
Objectives
To validate these prediction models externally.
Methods
Within the MEGA follow‐up study (n = 3750), we externally validated the Vienna and DASH score. These models were validated (a) by using the original study's criteria for patients with unprovoked VT and (b) by using our own criteria for unprovoked VT. In addition, absolute recurrence risks based on individual VT risk factors were calculated.
Results
The recurrence rate was 5.2 (95% CI, 4.6‐5.9) per 100 patient‐years in those who had a first unprovoked VT according to our definition. For the Vienna model it was 3.4 per 100 patient‐years and for DASH 3.8 per 100 patient‐years. The C‐statistic was 0.62 for Vienna and 0.65 for DASH. The C‐statistic declined to 0.58 for both Vienna and DASH when we used our own definition of “unprovoked VT.” Within the provoked group a strong gradient in risk was found dependent on the presence of traditional risk factors or biomarkers in a patient.
Conclusions
The ability to distinguish patients’ recurrence risks is lower than proposed in the original prediction model studies and dependent on the definition that is used for an unprovoked first event. Furthermore, our results suggest that a more‐refined risk estimation is possible, also in patients with a provoked first event, who are currently all classified as low risk.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anticoagulants - therapeutic use</subject><subject>Area Under Curve</subject><subject>Case-Control Studies</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Models, Biological</subject><subject>Original</subject><subject>Patients</subject><subject>Practice Guidelines as Topic</subject><subject>prediction</subject><subject>Prediction models</subject><subject>Prognosis</subject><subject>Pulmonary Embolism - epidemiology</subject><subject>Pulmonary Embolism - etiology</subject><subject>Recurrence</subject><subject>recurrent venous thrombosis</subject><subject>Risk</subject><subject>Risk factors</subject><subject>ROC Curve</subject><subject>Severity of Illness Index</subject><subject>Thrombophilia - complications</subject><subject>Thrombophilia - diagnosis</subject><subject>Thrombophilia - drug therapy</subject><subject>THROMBOSIS</subject><subject>validation</subject><subject>Validation Studies as Topic</subject><subject>venous thrombosis</subject><subject>Venous Thrombosis - blood</subject><subject>Venous Thrombosis - drug therapy</subject><subject>Venous Thrombosis - epidemiology</subject><subject>Venous Thrombosis - etiology</subject><subject>Young Adult</subject><issn>1538-7933</issn><issn>1538-7836</issn><issn>1538-7836</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>WIN</sourceid><sourceid>EIF</sourceid><recordid>eNp1kV9LwzAUxYMobk4f_AIS8MmHbk3TtCmCIkOdMhBkew5pc-s6t2Ym7cq-van7gz4YCAk3P849NwehS-L3iVuDeTXrk5BRdoS6hFHuxZxGx_t7QmkHnVk7932SsMA_RR1KCOeMsC6avhf2E68MqCKrCl1inWMDWW0MlBVeQ6lri6uZ0ctU28Le4mYGBrB0uwFc6gbLUrmirHAmy7Ymlbo_Rye5XFi42J09NH16nAxH3vjt-WX4MPayMKTMCwiEkUxBSp5DHjJQENOcpWEcJD4JWEKyOPYjrlSWcEiZYpxEnLvhojxXaUJ76G6ru6rTJajMeTZyIVamWEqzEVoW4u9LWczEh16LqJ0-bAWudwJGf9VgKzHXtSmdZxEEnNKAsZg56mZLZUZbayA_dCC-aBMQLgHxk4Bjr35bOpD7L3fAYAs0xQI2_yuJ18loK_kNngWQ7Q</recordid><startdate>201909</startdate><enddate>201909</enddate><creator>Timp, Jasmijn F.</creator><creator>Lijfering, Willem M.</creator><creator>Rosendaal, Frits R.</creator><creator>Cessie, Saskia</creator><creator>Cannegieter, Suzanne C.</creator><general>Elsevier Limited</general><general>John Wiley and Sons Inc</general><scope>24P</scope><scope>WIN</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>H94</scope><scope>K9.</scope><scope>5PM</scope></search><sort><creationdate>201909</creationdate><title>Risk prediction of recurrent venous thrombosis; where are we now and what can we add?</title><author>Timp, Jasmijn F. ; Lijfering, Willem M. ; Rosendaal, Frits R. ; Cessie, Saskia ; Cannegieter, Suzanne C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4435-21e46abeaa8fef45ede73f5b4729012591c77068ddc98eb5d5816888366ffdb93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anticoagulants - therapeutic use</topic><topic>Area Under Curve</topic><topic>Case-Control Studies</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Models, Biological</topic><topic>Original</topic><topic>Patients</topic><topic>Practice Guidelines as Topic</topic><topic>prediction</topic><topic>Prediction models</topic><topic>Prognosis</topic><topic>Pulmonary Embolism - epidemiology</topic><topic>Pulmonary Embolism - etiology</topic><topic>Recurrence</topic><topic>recurrent venous thrombosis</topic><topic>Risk</topic><topic>Risk factors</topic><topic>ROC Curve</topic><topic>Severity of Illness Index</topic><topic>Thrombophilia - complications</topic><topic>Thrombophilia - diagnosis</topic><topic>Thrombophilia - drug therapy</topic><topic>THROMBOSIS</topic><topic>validation</topic><topic>Validation Studies as Topic</topic><topic>venous thrombosis</topic><topic>Venous Thrombosis - blood</topic><topic>Venous Thrombosis - drug therapy</topic><topic>Venous Thrombosis - epidemiology</topic><topic>Venous Thrombosis - etiology</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Timp, Jasmijn F.</creatorcontrib><creatorcontrib>Lijfering, Willem M.</creatorcontrib><creatorcontrib>Rosendaal, Frits R.</creatorcontrib><creatorcontrib>Cessie, Saskia</creatorcontrib><creatorcontrib>Cannegieter, Suzanne C.</creatorcontrib><collection>Wiley-Blackwell Open Access Collection</collection><collection>Wiley Online Library Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of thrombosis and haemostasis</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Timp, Jasmijn F.</au><au>Lijfering, Willem M.</au><au>Rosendaal, Frits R.</au><au>Cessie, Saskia</au><au>Cannegieter, Suzanne C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Risk prediction of recurrent venous thrombosis; where are we now and what can we add?</atitle><jtitle>Journal of thrombosis and haemostasis</jtitle><addtitle>J Thromb Haemost</addtitle><date>2019-09</date><risdate>2019</risdate><volume>17</volume><issue>9</issue><spage>1527</spage><epage>1534</epage><pages>1527-1534</pages><issn>1538-7933</issn><issn>1538-7836</issn><eissn>1538-7836</eissn><abstract>Background
Several models are available to predict recurrent venous thrombosis (VT) in patients with unprovoked first events.
Objectives
To validate these prediction models externally.
Methods
Within the MEGA follow‐up study (n = 3750), we externally validated the Vienna and DASH score. These models were validated (a) by using the original study's criteria for patients with unprovoked VT and (b) by using our own criteria for unprovoked VT. In addition, absolute recurrence risks based on individual VT risk factors were calculated.
Results
The recurrence rate was 5.2 (95% CI, 4.6‐5.9) per 100 patient‐years in those who had a first unprovoked VT according to our definition. For the Vienna model it was 3.4 per 100 patient‐years and for DASH 3.8 per 100 patient‐years. The C‐statistic was 0.62 for Vienna and 0.65 for DASH. The C‐statistic declined to 0.58 for both Vienna and DASH when we used our own definition of “unprovoked VT.” Within the provoked group a strong gradient in risk was found dependent on the presence of traditional risk factors or biomarkers in a patient.
Conclusions
The ability to distinguish patients’ recurrence risks is lower than proposed in the original prediction model studies and dependent on the definition that is used for an unprovoked first event. Furthermore, our results suggest that a more‐refined risk estimation is possible, also in patients with a provoked first event, who are currently all classified as low risk.</abstract><cop>England</cop><pub>Elsevier Limited</pub><pmid>31188515</pmid><doi>10.1111/jth.14535</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 1538-7933 |
| ispartof | Journal of thrombosis and haemostasis, 2019-09, Vol.17 (9), p.1527-1534 |
| issn | 1538-7933 1538-7836 1538-7836 |
| language | eng |
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| source | MEDLINE; Alma/SFX Local Collection; EZB Electronic Journals Library |
| subjects | Adolescent Adult Aged Aged, 80 and over Anticoagulants - therapeutic use Area Under Curve Case-Control Studies Female Follow-Up Studies Humans Male Middle Aged Models, Biological Original Patients Practice Guidelines as Topic prediction Prediction models Prognosis Pulmonary Embolism - epidemiology Pulmonary Embolism - etiology Recurrence recurrent venous thrombosis Risk Risk factors ROC Curve Severity of Illness Index Thrombophilia - complications Thrombophilia - diagnosis Thrombophilia - drug therapy THROMBOSIS validation Validation Studies as Topic venous thrombosis Venous Thrombosis - blood Venous Thrombosis - drug therapy Venous Thrombosis - epidemiology Venous Thrombosis - etiology Young Adult |
| title | Risk prediction of recurrent venous thrombosis; where are we now and what can we add? |
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