Effect of tailoring anticoagulant treatment duration by applying a recurrence risk prediction model in patients with venous thromboembolism compared to usual care: A randomized controlled trial

Abstract

Background Patients with unprovoked (i.e., without the presence of apparent transient risk factors such as recent surgery) venous thromboembolism (VTE) are at risk of recurrence if anticoagulants are stopped after 3-6 months, yet their risk remains heterogeneous. Thus, prolonging anticoagulant treatment should be considered in high-risk patients, whereas stopping is likely preferred in those with a low predicted risk. The Vienna Prediction Model (VPM) could aid clinicians in estimating this risk, yet its clinical effects and external validity are currently unknown. The aim of this study was to investigate the clinical impact of this model on reducing recurrence risk in patients with unprovoked VTE, compared to usual care. Methods and findings In a randomized controlled trial, the decision to prolong or stop anticoagulant treatment was guided by predicted recurrence risk using the VPM (n = 441), which was compared with usual care (n = 442). Patients with unprovoked VTE were recruited from local thrombosis services in the Netherlands (in Utrecht,

Long‐term risk of recurrent venous thromboembolism among patients receiving extended oral anticoagulant therapy for first unprovoked venous thromboembolism: A systematic review and meta‐analysis

“…Of the 26 included studies, 12,26–49 14 were RCTs and 12 were prospective cohort studies with a total of 15 603 patients with a first unprovoked or weakly provoked VTE who, after having completed at least 3 months of initial anticoagulant treatment, received extended anticoagulation (Table 1). The duration of initial anticoagulant treatment was exclusively 3 months in 12 studies (Table 1).…”

Clinical impact and quality of randomized controlled trials involving interventions evaluating artificial intelligence prediction tools: a systematic review

“…In doing the assessment, we focused on randomization and masking. Some of the trials [51][52][53] gave the reason why they did not use masking for its difficulty or its nature of the intervention, and some would be not influenced by non-masking [54][55][56] . Masking was also related to study design (i.e.…”

Current Trends in the Duration of Anticoagulant Therapy for Venous Thromboembolism: A Systematic Review

“…Inclusion and exclusion criteria were applied and only relevant research regarding our research question were considered. A total of 31 articles were kept (Figure 1 ) [ 10 - 40 ].…”

“…Ultimately, 31 articles were included in this review of which were primarily focused on standard anticoagulation therapies using VKAs, LMWH, warfarin, etc. and another 14 were primarily focused on factor Xa inhibitors, NOACs, or DOACs; six other articles were using mixed therapies or therapies not previously mentioned [ 10 - 40 ].…”