Risk of recurrence after a first unprovoked venous thromboembolism: External validation of the Vienna Prediction Model using pooled individual patient data.
J Thromb Haemost. 2015 Feb 7;
Authors: Marcucci M, Iorio A, Douketis JD, Eichinger S, Tosetto A, Baglin T, Cushman M, Palareti G, Poli D, Tait RC, Kyrle PA
BACKGROUND: In order to stratify patients with a first unprovoked venous thromboembolism (VTE) according to their recurrence risk and identify those that would actually benefit from an indefinite anticoagulation, three prediction models have been so far developed; none of them has been yet externally validated.
OBJECTIVE: To externally validate the Vienna Prediction Model (VPM), a prediction guide to estimate the recurrence risk after a first unprovoked VTE developed through Cox modeling and including sex, D-dimer and index VTE site as predictors.
PATIENTS/METHODS: 904 patients pooled from 5 prospective studies evaluating the prognostic value of D-dimer for VTE recurrence served as validation cohort. The validity of the VPM in stratifying patients according to their relative recurrence risk (discrimination) and in predicting the absolute recurrence risk (calibration) was tested using survival analysis methods.
RESULTS: The ability of the VPM to distinguish patients' risk for recurrent VTE in the validation cohort was at least as good as in the original cohort, with a calibration slope of 1.17 (95% confidence interval: 0.71 to 1.64; p for the hypothesis of a significant difference from 1: 0.456), and a c statistic of 0.626 (versus 0.651 found in the original derivation cohort). The VPM absolute predictions in terms of cumulative rates tended to underestimate the observed recurrence rates at 12 months.
CONCLUSIONS: Using a pooled Individual patient database as a validation cohort we confirmed the ability of the Vienna Prediction Model in stratifying patients with a first unprovoked VTE according to their risk of recurrence. This article is protected by copyright. All rights reserved.
PMID: 25660555 [PubMed - as supplied by publisher]