Predicting the risk of recurrent venous thrombosis: What the future might bring.
An important clinical problem in the management of venous thrombosis is to determine whether a patient can safely cease anticoagulant therapy. In this Forum article, we summarize the predictive performance of several prediction models for recurrent thrombosis, as well as for bleeding while using anticoagulants. Patients with provoked first thrombosis (considered "low risk") are now denied long-term treatment, although a strong gradient in risk can be found in this group. We furthermore discuss the problem of an unclear definition of "(un)provoked" and show that this affects the yield of currently available prediction scores plus the limitations of a "one-size-fits-all" strategy. Better prediction tools are urgently needed. We propose a strategy for future studies for which the following should be considered: (a) reporting of absolute risks next to C-statistics, (b) model applicable to all patients, (c) no discontinuation of anticoagulation for measurement of predictors.
['Lijfering|Willem M|WM|', 'Timp|Jasmijn F|JF|', 'Cannegieter|Suzanne C|SC|']
D000367:Age Factors D000925:Anticoagulants D019540:Area Under Curve D002986:Clinical Trials as Topic D015897:Comorbidity D005544:Forecasting D006470:Hemorrhage D020249:Hormone Replacement Therapy D006801:Humans D009369:Neoplasms D009765:Obesity D017410:Practice Guidelines as Topic D011379:Prognosis D012372:ROC Curve D012008:Recurrence D012306:Risk D012737:Sex Factors D019851:Thrombophilia D020246:Venous Thrombosis
risk venous thrombosis epidemiology expert testimony prognosis secondary prevention