Background: The Vienna prediction model (VPM) estimates the recurrence risk of patients with a first unprovoked deep-vein thrombosis (DVT) of the leg and/or pulmonary embolism (PE). Its ability to identify low-risk patients who might not benefit from extended anticoagulation is under investigation (VPM-VALID).
Aims: This analysis aimed to study the patients at high risk of recurrence (> 180 VPM risk points) who were not included in VPM-VALID.
Methods: High-risk patients were referred to their local physician for further management and were contacted by questionnaire after 12 to 16 months.
Results:
| Characteristic | All patients (n = 264)* |
Patients resuming anticoagulation (n=177) |
Patients not resuming anticoagulation (n=73) |
| Age (yrs) | 56 (45, 68) | 56 (45, 67) | 57 (48, 70) |
| Sex n (%) Male Female |
253 (96) 11 (4) |
171 (97) 6 (3) |
69 (95) 4 (5) |
| Location of index event n (%) Proximal DVT Distal DVT PE |
81 (31) 0 183 (69) |
53 (30) 0 124 (70) |
24 (33) 0 49 (67) |
| Anticoagulation before VPM risk assessment (mo) | 4.4 (3.4, 5.7) | 4.4 (3.4, 5.7) | 4.3 (3.4, 5.6) |
| Follow-up (mo) | 13.5 (11.9, 16.3) | 12.8 (11.9, 14.8) | 16.1 (13.4, 17.4) |
| D-Dimer (ng/ml) | 500 (320, 750) | 510 (320, 770) | 510 (410, 810) |
| VPM-RAS (points) | 195 (188, 210) | 195 (188, 210) | 199 (189, 206) |
| Values are medians (interquartile range) or absolute frequency (%) * including 14 patients who were lost-to-follow-up |
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Cumulative probability of recurrent VTE. Seventy-three patients did not resume anticoagulation after VPM risk assessment.
We studied 264 patients of whom 14 were lost-to-follow-up. Their median age was 56 years, 96% were male and the median follow-up was 13.5 months (Table). After VPM risk assessment, anticoagulation (preferably with a direct oral anticoagulant) was restarted in 177 patients of whom none had recurrence. Five patients had non-major clinically relevant bleeding [unadjusted bleeding risk 2.5 (95% CI: 0.8, 5.8) events per 100 patient-years]. Seventy-three patients were left untreated of whom 15 (21%) had recurrence. The cumulative recurrence risk was 9.9% (95% CI: 2.9, 16.9) after 6 months and 17.1% (95 % CI: 8.2, 26) after 1 year (Figure).
Demographics of 264 patients with a VPM-RAS of more than 180 points.
Conclusions: In conclusion, anticoagulant therapy is effective in patients with an unprovoked DVT of the leg and/or PE at high risk of recurrence as estimated by the VPM. The risk of bleeding during extended anticoagulation is low. The risk of VTE recurrence is high if patients are left untreated. The VPM might be used to gauge patients with a high recurrence risk who would benefit from extended anticoagulation.
To cite this abstract in AMA style:
Eischer L, Šinkovec H, Gressenberger P, Gary T, Brodmann M, Heinze G, Kyrle PA, SE. Management of Patients with Venous Thromboembolism and a High Recurrence Risk Estimated by the Vienna Prediction Model [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/management-of-patients-with-venous-thromboembolism-and-a-high-recurrence-risk-estimated-by-the-vienna-prediction-model/. Accessed November 27, 2021.« Back to ISTH 2021 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/management-of-patients-with-venous-thromboembolism-and-a-high-recurrence-risk-estimated-by-the-vienna-prediction-model/