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Patient Evidence Summary
Doctor, what is my risk of having another DVT or PE compared to my risk of bleeding, if I stay on blood thinners longer than 3 months or if I stop?
The VTE-PREDICT risk score is a tool that can be used by your doctor to help you to decide if you should continue or stop anticoagulants after 3 months of treatment. This supports shared decision-making.
Study highlights
In people with a history of DVT or PE, the VTE-PREDICT score predicted with moderate accuracy, the 5-year risk of another DVT or PE compared to the risk of bleeding when continuing versus stopping anticoagulants after 3 months of treatment.
Understanding the problem
When a DVT or PE develops due to a strong risk factor for VTE, such as surgery or trauma, people are generally treated with anticoagulants only for 3 months because the future risk of another DVT or PE is low. However, for some people, the risk factor that caused their DVT or PE is either weak (for example, long travel) or is unknown. For those people, it is unclear if they should continue blood thinners longer than 3 months or if they should stop. Staying on long-term anticoagulants reduces the risk of having another DVT or PE, but it also increases the risk of bleeding.
To help you to decide if you should continue your anticoagulants indefinitely, your and your doctor need to compare your risk of having another DVT or PE if you stop taking anticoagulants with your risk of bleeding if you continue taking anticoagulants. None of the available tools (also known as scores) compare the risk of having another DVT or PE with the risk of bleeding within the same score. This is important since the decision about continuing long-term anticoagulants needs to be individualized. Not everyone has the same risk of having another DVT or PE and not everyone has the same risk of bleeding.
In this study, researchers created and tested the VTE-PREDICT tool. They developed this tool using information from one group of people who had DVT or PE who had been treated for at least 3 months and then, they tested the tool by calculating the score for another group of people who had already made the decision to continue or stop anticoagulants and had been followed for 5 years.
Who? The study included a total of 74,398 people with DVT or PE without cancer who had completed at least 3 months of anticoagulation. They were separated into two groups.
What? The researchers used the first group of people to find which factors seemed were connected to whether a person had a new DVT or PE or a bleed. They they used these 13 factors, also known as predictors (in the table below), to calculate the VTE-PREDICT risk score for people in the second group to see how accurate the tool was at predicting the 5-year risk of new DVT or PE and bleeding in that group.
VTE-PREDICT Predictors |
|---|
Patient characteristics and physical examination
Details about their first blood clot
Medical history
Lab values
Taking other medications
Calculator available online: https://vtepredict.com/ |
Performance of the VTE-PREDICT risk score to predict the 5-year risk of having another DVT or PE or bleeding in people who were treated with anticoagulants for at least 3 months and either continued or stopped anticoagulants at that point
VTE-PREDICT risk score | Number of people | Number of people with new DVT or PE (%) | Performance of the score in predicting new DVT or PE | Number of people with bleeding (%) | Performance of the score in predicting bleeding |
|---|---|---|---|---|---|
Group of people used to test the score | 59,257 | 2,283 (3.9%) | Moderate | 3,335 (5.6%) | Moderate |
This Evidence Summary is based on the following article:
de Winter MA, Buller HR, Carrier M, et al. Recurrent venous thromboembolism and bleeding with extended anticoagulation: the VTE-PREDICT risk score. Eur Heart J. 2023 Jan 17:ehac776. doi: 10.1093/eurheartj/ehac776. PubMed
Vicky Mai, MD, MSc
Vicky Mai is a fellow in the Adult Thrombosis Medicine program and a PhD epidemiology candidate at the University of Ottawa, co-supervised by Dr. Grégoire Le Gal and Dr. Dean Fergusson. She completed medical school, internal medicine residency, respirology training and a Master's in Clinical Epidemiology at Laval University and completed a thoracic oncology fellowship at the University of Toronto. Her thrombosis research fellowship is supported by the Canadian Institutes of Health Research, the Fonds de Recherche du Québec – Santé, the CanVECTOR Network and the Faculty of Medicine of Laval University. She had also received support from the Royal College of Physicians and Surgeons of Canada with the Detweiler Travelling Fellowship.
Lori-Ann Linkins, MD, MSc (Clin Epi), FRCPC
Dr. Linkins is an Associate Professor of Medicine (thrombosis) at McMaster University in Hamilton, Canada. She holds a Masters Degree in Health Research Methodology and is a Deputy Editor with the Health Information Research Unit, McMaster. She is Co-Editor of the ACP Journal Club and Co-lead on the CanVECTOR Knowledge Translation Platform.
Published: Monday, April 3, 2023
Please note that the information contained herein is not to be interpreted as an alternative to medical advice from a professional healthcare provider. If you have any questions about any medical matter, you should consult your professional healthcare providers, and should never delay seeking medical advice, disregard medical advice or discontinue medication based on information provided here.
, McMaster University