The Vienna Prediction Model adequately identified patients with unprovoked VTE at low risk for recurrence, with an observed 1-year recurrence rate of 5.2% (95% CI 3.2-7.2).
Cohort (n=520)
Does the Vienna Prediction Model accurately identify patients with unprovoked VTE at low risk of recurrence?
The Vienna Prediction Model accurately predicts a 1-year VTE recurrence risk of ~5.2% in low-risk patients, but underestimates risk at 2 years, requiring recalibration for extended prediction.
BACKGROUND AND AIMS: Patients with unprovoked venous thromboembolism (VTE) have a high recurrence risk, and guidelines suggest extended-phase anticoagulation. Many patients never experience recurrence but are exposed to bleeding. The aim of this study was to assess the performance of the Vienna Prediction Model (VPM) and to evaluate if the VPM accurately identifies these patients. METHODS: In patients with unprovoked VTE, the VPM was performed 3 weeks after anticoagulation withdrawal. Those with a predicted 1-year recurrence risk of ≤5.5% were prospectively followed. Study endpoint was recurrent VTE over 2 years. RESULTS: A total of 818 patients received anticoagulation for a median of 3.9 months. 520 patients (65%) had a predicted annual recurrence risk of ≤5.5%. During a median time of 23.9 months, 52 patients had non-fatal recurrence. The recurrence risk was 5.2% 95% confidence interval (CI) 3.2-7.2 at 1 year and 11.2% (95% CI 8.3-14) at 2 years. Model calibration was adequate after 1 year. The VPM underestimated the recurrence risk of patients with a 2-year recurrence rate of >5%. In a post-hoc analysis, the VPM's baseline hazard was recalibrated. Bootstrap validation confirmed an ideal ratio of observed and expected recurrence events. The recurrence risk was highest in men with proximal deep-vein thrombosis or pulmonary embolism and lower in women regardless of the site of incident VTE. CONCLUSIONS: In this prospective evaluation of the performance of the VPM, the 1-year rate of recurrence in patients with unprovoked VTE was 5.2%. Recalibration improved identification of patients at low recurrence risk and stratification into distinct low-risk categories.
“The Vienna Prediction Model can help to identify patients with VTE who have a low risk of recurrence. For this group, the therapy can be changed in such a way that blood thinners can be dispensed with altogether. In addition to gaining quality of life, they also benefit from eliminating the bleeding risk associated with blood thinners.”
Kyrle et al. (Thu,) conducted a cohort in unprovoked venous thromboembolism (n=520). Vienna Prediction Model was evaluated on recurrent VTE at 1 year (95% CI 3.2-7.2). The Vienna Prediction Model adequately identified patients with unprovoked VTE at low risk for recurrence, with an observed 1-year recurrence rate of 5.2% (95% CI 3.2-7.2).