| アブストラクト | BACKGROUND: Predicting the risk of recurrent venous thromboembolism (rVTE) during and after anticoagulation is complex. Current models do not adapt to changing patient conditions, fail to account for the direct impact of anticoagulation in real-world settings, and are often derived without concurrent data on major bleeding. OBJECTIVES: To develop a dynamic, broad, treatment-adjusted risk score for rVTE. METHODS: We analyzed data from a retrospective cohort of patients from the UK Clinical Practice Research Datalink (2001-2020) with a first venous thromboembolism (VTE) who received 3 months of anticoagulation. rVTE risk was modeled using baseline and time-varying covariates (post-VTE). Hazard ratios with 95% CIs were estimated; a Fine-Gray model identified predictors. A scoring scheme was developed from subdistribution hazard ratios, with discrimination (C-statistic) estimated via cross-validation. RESULTS: A total of 51 465 patients with VTE were included; 4041 cases of rVTE occurred over 200 698 person-years. rVTE incidence was 2.01 per 100 person-years. The model included 19 predictors, of which 13 were associated with increased rVTE risk and 6 with decreased rVTE risk. Risk correlated well with outcomes; calibration showed good agreement between predicted and observed risks (calibration slope, 0.99 [95% CI, 0.94-1.04]). rVTE risk decreased over 10 years, but within each year, higher scores were associated with higher risk (0.92%-21.23% in the first year [-5 to +8 points]). The C-statistic (0.65 [95% CI, 0.64-0.66]) was stable over 10 years. CONCLUSION: Our dynamic risk score effectively identifies the risk of rVTE after 3 months of treatment and supports ongoing management over 10 years, aiding clinical decision-making regarding treatment duration and strategy adjustments as patient characteristics and comorbidities evolve. |
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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 | Cohen, Alexander T; Choudhuri, Satarupa; Khan, Imran; Pollock, Kevin G; Bober-Irizar, Mikel; Galias, Zbigniew; Irizar, Amaia; Bober, Miroslaw |
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| 組織名 | Department of Haematology, Guy's and St Thomas' Hospitals National Health Service;Foundation Trust, King's College London, London, United Kingdom. Electronic;address: alexander.cohen@kcl.ac.uk.;Department of Haematological Medicine, Northern Care Alliance National Health;Service Foundation Trust, Manchester, United Kingdom.;Pfizer Ltd, Tadworth, United Kingdom.;Bristol Myers Squibb Pharmaceuticals Ltd, Uxbridge, United Kingdom.;ForecomAI, London, United Kingdom.;ForecomAI, London, United Kingdom; AGH University of Krakow, Krakow, Poland.;ForecomAI, London, United Kingdom; University of Surrey, Surrey Institute for;People-Centred AI, Guildford, United Kingdom. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/42315028/ |
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