Predicting Recurrence after a First Unprovoked Venous Thromboembolism: Retrospective Validation of the DAMOVES Score

Moreno, Àngel; Navarro, María José García; Aracil, Cristina Lucía De Ancos; García, A. Gimeno; Hernandez, Christie; Martínez, Álvaro; Mateo, Véronique; Sánchez, J. Ortiz; Acevedo, I. C. Sanz; Díaz, R. Martín; Giardín, José Manuel Ruiz

doi:10.3390/proceedings2090528

Cited by 4 publications

(4 citation statements)

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“…Attempts to refine risk prediction for VTE recurrence have been made. 20,[30][31][32][33][34] However, most of these prediction models were developed only for patients with "unprovoked," [30][31][32][33] and the models have been sparsely validated, [35][36][37][38] and none are implemented in the guidelines. We used the AIM-SHA-RP risk score in the current study.…”

Section: Discussionmentioning

confidence: 99%

Risk of Recurrent Venous Thromboembolism in Selected Subgroups of Men: A Danish Nationwide Cohort Study

Albertsen

Konstantinides

Piazza

et al. 2022

TH Open

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Background Although men are considered at high risk for recurrent venous thromboembolism (VTE), sex-specific data on prognostic factors are lacking. We estimated the cumulative recurrence risks associated with clinical characteristics and comorbidities known or suspected to be associated with the developing of VTE recurrence: major surgery, trauma, history of cancer, rheumatic disorder, ischemic heart disease, congestive heart failure, chronic obstructive pulmonary disease, diabetes, chronic renal disease, varicose veins, alcohol-related diseases, and arterial hypertension. Methods We linked nationwide Danish health registries to identify all incident VTE in- and outpatients in men from 2008 through 2018. Recurrent VTE risk two years after anticoagulant discontinuation was calculated using the Aalen-Johansen estimator, stratified by age above/below 50 years. Results The study included 13,932 men with VTE, of whom 21% (n=2,898) were aged < 50 years. For men aged < 50 years with at least one of the clinical characteristics, two-year recurrence risk ranged from 6% (major surgery) to 16% (history of cancer). For men ≥ 50 years with at least one of the characteristics, recurrence risk ranged from 7% (major surgery) to 12% (ischemic heart disease, chronic obstructive pulmonary disease, and chronic renal disease). Men aged < 50 and ≥ 50 years without the clinical characteristics all had a recurrence risk of 10%. Discussion We demonstrated a two-year recurrence risk of at least 6%, regardless of age category and disease status, in this nationwide cohort of men with VTE. The recurrence risk must be balanced against bleeding risk. However, the high recurrence risk across all subgroups might ultimately lead to greater emphasis on male sex in future guidelines focusing on optimized secondary VTE prevention.

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Section: Discussionmentioning

confidence: 99%

Risk of Recurrent Venous Thromboembolism in Selected Subgroups of Men: A Danish Nationwide Cohort Study

Albertsen

Konstantinides

Piazza

et al. 2022

TH Open

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“…D-dimer levels have been incorporated into several risk prediction models, including the Vienna score, the Males Continue and HERDOO2 rule, as well as the DASH and DAMOVES scores (►Table 10), [90][91][92][93][94] the last three of which have been recently validated. [95][96][97] Compared with a normal Ddimer level, an elevated D-dimer level measured on treatment or 1 month after stopping anticoagulation therapy is associated with about a twofold increased risk of recurrence. The risk of recurrence in men is twofold higher than that in women.…”

Section: Non-specific Reversal Agentsmentioning

confidence: 99%

The Non-Vitamin K Antagonist Oral Anticoagulants in Heart Disease: Section V—Special Situations

et al. 2018

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Non-vitamin K antagonist oral anticoagulants (NOACs) include dabigatran, which inhibits thrombin, and apixaban, betrixaban, edoxaban and rivaroxaban, which inhibit factor Xa. In large clinical trials comparing the NOACs with the vitamin K antagonist (VKA) warfarin, dabigatran, apixaban, rivaroxaban and edoxaban were at least as effective for stroke prevention in atrial fibrillation and for treatment of venous thromboembolism, but were associated with less intracranial bleeding. In addition, the NOACs are more convenient to administer than VKAs because they can be given in fixed doses without routine coagulation monitoring. Consequently, the NOACs are now replacing VKAs for these indications, and their use is increasing. Although, as a class, the NOACs have a favourable benefit-risk profile compared with VKAs, choosing among them is complicated because they have not been compared in head-to-head trials. Therefore, selection depends on the results of the individual trials, renal function, the potential for drug-drug interactions and preference for once-or twice-daily dosing. Ã Document Coordinators and joint SeniorIn addition, several 'special situations' were not adequately studied in the dedicated clinical trials. For these situations, knowledge of the unique pharmacological features of the various NOACs and judicious cross-trial comparison can help inform prescription choices. The purpose of this position article is therefore to help clinicians choose the right anticoagulant for the right patient at the right dose by reviewing a variety of special situations not widely studied in clinical trials.This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.Prevention of recurrent ischaemia following acute coronary syndrome Rivaroxaban 31 2.5 mg twice daily (not approved in the U.S.)Abbreviations: CrCl, creatinine clearance; NOAC, non-vitamin K antagonist oral anticoagulant; P-gp, P-glycoprotein. Edoxaban 33 Avoid use with rifampin Avoid use in patients with moderate or severe hepatic impairment (Child-Pugh B and C) Avoid use if CrCl < 15 mL/min No data for use in pregnancy or lactation or APS; contraindicated in mechanical heart valve or moderate to severe mitral stenosis Betrixaban 34 Reduce dose with concomitant use of P-gp inhibitors (e.g. amiodarone, azithromycin, verapamil, ketoconazole, clarithromycin)-initial single dose of 80 mg followed by 40 mg once daily Avoid use in patients with moderate or severe hepatic impairment (Child-Pugh B and C) Reduce dose if severe renal impairment (CrCl ! 15 to < 30 mL/min)-initial single dose of 80 mg followed by 40 mg once daily Avoid use if severe renal impairment coupled with P-gp inhibitorNo data for use in pregnancy or lactation; APS; contraindicated in mechanical heart valve or moderate to severe mitral stenosis Abbreviations: AF, atrial fibrillation; APS, anti-phospholipid antibody syndrome; CrCl, creatinine clearance; CYP, cytochrome P-450; P-gp, P glycoprotein; ULN, upper limit of normal.

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“…[9][10][11][12] Furthermore, none of the prediction models are implemented in guidelines and they have been sparsely validated. [14][15][16][17] Consequently, optimal duration of anticoagulation for patients suffering either a "provoked" or "unprovoked" venous thromboembolism is an ongoing critical clinical concern. 18 Men and women differ both in risk factors for recurrence (e.g., pregnancy/puerperium, hormone treatment) and in overall recurrence risk.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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.

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Predicting Recurrence after a First Unprovoked Venous Thromboembolism: Retrospective Validation of the DAMOVES Score

Cited by 4 publications

References 6 publications

Risk of Recurrent Venous Thromboembolism in Selected Subgroups of Men: A Danish Nationwide Cohort Study

Risk of Recurrent Venous Thromboembolism in Selected Subgroups of Men: A Danish Nationwide Cohort Study

The Non-Vitamin K Antagonist Oral Anticoagulants in Heart Disease: Section V—Special Situations

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

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