How to predict recurrent venous thromboembolism and bleeding? A review of recent advances and their implications

Abstract

Prediction of recurrent venous thromboembolism and bleeding: a review 1 factors (eg, major surgery or trauma with fractures). 6-9 In the case of minor transient risk factors (eg, hormone use, confinement to bed outside hospital, long -haul flights) some guidelines recommend or suggest to discontinue, 7-9 while other suggest to consider extended anticoagulant therapy. 6 It is advised that the decision to extend anticoagulant treatment should involve a discussion with the patient, in which the benefits and risks of continuing or stopping should be presented. 6-9Despite the above mentioned rough recommendations, in clinical practice it remains difficult to balance the risk of VTE recurrence and major bleeding on an individual level, as many situations are not straightforward. Thereby, it remains a challenging problem whether a patient should be advised an indefinite anticoagulant treatment after the first VTE. To provide tailored treatment

Tailored anticoagulant treatment after a first venous thromboembolism: protocol of the Leiden Thrombosis Recurrence Risk Prevention (L-TRRiP) study - cohort-based randomised controlled trial

“…Multiple prediction models have been developed to assess the risk of VTE recurrence and major bleeding in patients with VTE. 20 21 At the time we started to design the present study (2018), models for the prediction of VTE recurrence included the Men and HERDOO2 rule, Vienna prediction model, DASH score, DAMOVES score, pre and post D-dimer strategy, Worcester VTE score and L-TRRiP (Leiden Thrombosis Recurrence Risk Prevention) model. 17 22–27 Of these, the L-TRRiP model is the only externally validated model that predicts long-term recurrence risk after a provoked as well as an unprovoked first VTE, which allows for easier use given the problems related to the distinction between provoked and unprovoked VTE as described above.…”

Balancing the risks of recurrent venous thromboembolism and bleeding with extended anticoagulation: oh, for a crystal ball!

“…A dichotomous approach pivoting on the absence/presence of a provoking factor still dominates clinical decision-making; there is also increasing awareness on the contribution of additional variables to the recurrence risk, such as sex, site of the VTE, and D-dimer [ 8 ]. Various prediction models have been devised, with 17 models to predict recurrence and 15 to predict bleeding [ 9 ]. A latest such model, the VTE-PREDICT score, estimates absolute risk of recurrent VTE and clinically relevant bleeding for patients with VTE without active cancer after the initial period of anticoagulation [ 10 ].…”