Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, the Netherlands
Pol Arch Intern Med. 2023 May 23;133(5). doi: 10.20452/pamw.16492. Epub 2023 May 8.
After the first venous thromboembolism (VTE), anticoagulant treatment duration should be based on the balance between the risk of recurrence and bleeding. However, this decision is challenging on the individual level. Prediction models that accurately estimate these risks may help selecting patients that would benefit from either short or indefinite anticoagulant treatment. Currently, 17 models to predict VTE recurrence and 15 models to predict bleeding in VTE patients have been proposed. In addition, 7 models to predict bleeding in anticoagulated patients, mostly for atrial fibrillation, have been evaluated for use in VTE patients. Sex, age, type, and location of the index event and D‑dimer levels were the most often included predictors of recurrent VTE, whereas age, history of (major) bleeding, active malignancy, antiplatelet therapy, anemia, and renal insufficiency were most often used for the prediction of bleeding. In this review, we provide a summary of these models and their performance. Notably, these models are rarely used in clinical practice and none of them is incorporated in current guidelines due to insufficient accuracy or insufficient validation. Moreover, evidence supporting the value of implementing these models is still lacking. Before these models can be used in routine care, further refinement may be required, and their added value and feasibility should be proven in both management and implementation studies.
首次发生静脉血栓栓塞症（VTE）后，抗凝治疗的持续时间应基于复发风险和出血风险之间的平衡。然而，在个体层面上，这一决策颇具挑战。能够准确评估这些风险的预测模型或有助于筛选出那些适合接受短期或无限期抗凝治疗的患者。目前，已经提出了 17 种用于预测 VTE 复发的模型和 15 种用于预测 VTE 患者出血的模型。此外，还评估了 7 种用于预测抗凝治疗患者出血的模型，其中大多数是针对心房颤动患者的，也可用于 VTE 患者。性别、年龄、首发事件的类型和部位以及 D-二聚体水平是预测 VTE 复发的最常包含的预测因子，而年龄、（重大）出血史、活动性恶性肿瘤、抗血小板治疗、贫血和肾功能不全是预测出血的最常使用的预测因子。在这篇综述中，我们对这些模型及其性能进行了总结。值得注意的是，这些模型在临床实践中很少使用，由于准确性不足或验证不足，目前的指南均未纳入这些模型。此外，仍然缺乏关于实施这些模型价值的证据。在这些模型可用于常规护理之前，可能需要进一步改进，并且应在管理和实施研究中证明其附加价值和可行性。
