Background: Patients with a first venous thromboembolism (VTE) are at risk of recurrence (rVTE). A rVTE can be prevented by prolonged anticoagulant therapy, but this may come at the cost of major bleeding (MB). The L-TRRiP and VTE-BLEED prediction scores have been developed to classify the risk of rVTE (low, intermediate, high) and MB (low vs high), respectively (table). However, their combined use in finding the optimal balance to minimize both long-term risks is unclear.
| L-TRRiP score (risk of recurrent VTE) |
VTE-BLEED score (risk of major bleeding) |
|---|---|
| Male sex | Active cancer |
| Type of first VTE (PE, PE +DVT) | Male with uncontrolled arterial hypertension |
| Location of DVT (popliteal DVT) | Anemia |
| Surgery Plaster cast Immobility in bed, in hospital |
History of bleeding |
| Pregnancy/puerperium Hormone use |
Age ≥ 60 years old |
| History of cardiovascular disease | Renal dysfunction |
| Blood group, non-O | |
| Factor V Leiden mutation |
Factors in the L-TRRiP and VTE-BLEED models
Aims: To evaluate tailored duration of long-term anticoagulant treatment based on individualized risk assessments of rVTE and MB risks.
Methods: The L-TRRiP study is a multicenter, open-label, cohort based randomized controlled trial including 1600 participants with a first VTE. After the initial three months of anticoagulant treatment, each patient’s individual rVTE and MB risk will be determined using the L-TRRiP and VTE-BLEED prediction scores, respectively. Patients with a low rVTE risk will discontinue anticoagulants, whereas patients with a high rVTE risk and low MB risk will continue. The other groups, with unclear benefit of prolonged treatment, will be randomized to continue or discontinue anticoagulants (figure). The primary outcome is the incidence of rVTE and MB in the randomized group after 2 years follow-up. Secondary outcomes are quality of life, cost-effectiveness and functional outcomes in all groups and incidence of rVTE and MB in the non-randomized groups. The study has been approved by the Medical Ethics Committee Leiden Den Haag Delft. All participants will provide informed consent. The L-TRRiP study is funded by ZonMw, the Netherlands; grant number: 848017007.
Design of the L-TRRiP study
Results: Results are expected in 2025.
Conclusions: The L-TRRiP study will assess whether a tailored strategy, based on classification of both rVTE risk and MB risk, leads to minimized risks of both complications.
To cite this abstract in AMA style:
Burggraaf JLI, van Rein N, Bemelmans RHH, Benimadho S, van den Berg JWK, Coppens M, Dees A, Faber LM, de Jong WK, Koster T, Mairuhu ATA, Meijer K, Nijkeuter M, van den Akker - van Marle ME, le Cessie S, Huisman MV, Klok FA, Cannegieter SC, L-TRRiP study investigators . Tailored Anticoagulant Treatment after a First Venous Thromboembolism: Protocol of the Leiden Thrombosis Recurrence Risk Prevention (L-TRRiP) Study, a Cohort Based Randomized Controlled Trial [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/tailored-anticoagulant-treatment-after-a-first-venous-thromboembolism-protocol-of-the-leiden-thrombosis-recurrence-risk-prevention-l-trrip-study-a-cohort-based-randomized-controlled-trial/. Accessed November 30, 2023.« Back to ISTH 2021 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/tailored-anticoagulant-treatment-after-a-first-venous-thromboembolism-protocol-of-the-leiden-thrombosis-recurrence-risk-prevention-l-trrip-study-a-cohort-based-randomized-controlled-trial/