| アブストラクト | BACKGROUND: After 3 months of treatment, clinicians and patients need to decide whether to continue anticoagulant therapy long-term, which is informed by bleeding risk; to date, we have not had a good way to estimate that risk. OBJECTIVES: To develop a dynamic, broad, treatment-adjusted risk score for clinically significant bleeding (CSB). METHODS: UK Clinical Practice Research Datalink (2001-2020) was used to generate a retrospective cohort of patients with first VTE who had received 3 months of anticoagulation. Covariates were collected at baseline and as time-varying data. Hazards with 95% confidence intervals (CIs) were estimated using a Fine-Gray model. A dynamic model with an additive (logarithmic) scoring scheme was developed from sub-distribution hazard ratios. Discrimination was expressed by the C-statistic. RESULTS: In 51,621 patients with VTE, 3301 CSB events were identified in 206,298 person-years of observation. The 10-year incidence rate for CSB was 1.60 per 100 person-years. The model incorporated 18 independent predictors of CSB, assigning risk scores from 0 to >/=14. Risk of CSB decreased over 10 years but within each year it increased by point category; ranging from 0.60% to 18.1% in the first year (0->/=14 points). Calibration slopes were 0.81 (0.76-0.87) base model, 0.95 (0.88-1.02) extended model; absolute intercepts <0.001 in both. Discrimination was stable, C-statistic 0.78 (0.77-0.79). CONCLUSIONS: Our dynamic score effectively identifies patients at risk of CSB, following 3 months of anticoagulant therapy, with good discrimination. It enables dynamic prediction of bleeding risk over time, accounting for anticoagulation status. |
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| ジャーナル名 | Journal of thrombosis and haemostasis : JTH |
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| Pubmed追加日 | 2026/6/19 |
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| 投稿者 | Choudhuri, Satarupa; Cohen, Alexander T; Khan, Imran; Pollock, Kevin G; Bober-Irizar, Mikel; Galias, Zbigniew; Irizar, Amaia; Bober, Miroslaw |
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| 組織名 | Northern Care Alliance NHS Foundation Trust, Manchester, UK.;Guy's and St Thomas' Hospitals NHS Foundation Trust, King's College London, UK.;Electronic address: alexander.cohen@kcl.ac.uk.;Pfizer Ltd, Tadworth, UKǁE;Bristol Myers Squibb Pharmaceuticals Ltd, Uxbridge, UKǁE;ForecomAI, London, UK.;ForecomAI, London, UK; AGH University of Krakow, Krakow, Poland.;ForecomAI, London, UK; University of Surrey, Surrey Institute for People-Centred;AI (PAI), Guildford, UK. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/42315025/ |
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