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Semin Thromb Hemost
DOI: 10.1055/s-0045-1807262
Review Article

Prediction of Recurrent Venous Thromboembolism and Arterial Cardiovascular Events after Discontinuation of Anticoagulation: The R-VTE-predict and MACE-predict Risk Scores

Steve R. Noumegni
1   Division of Cardiology, Cardiovascular Research Center, University of Florida College of Medicine, Jacksonville, Florida
2   Inserm, UMR 1304 (GETBO), University of Brest, France
,
Benjamin Espinasse
2   Inserm, UMR 1304 (GETBO), University of Brest, France
3   Internal Medicine, Vascular Medicine and Pneumology Department, CHU Brest, Brest, France
,
Romain Didier
2   Inserm, UMR 1304 (GETBO), University of Brest, France
4   Cardiology Department, CHU Brest, Brest, France
,
Raphael Le Mao
2   Inserm, UMR 1304 (GETBO), University of Brest, France
3   Internal Medicine, Vascular Medicine and Pneumology Department, CHU Brest, Brest, France
,
Claire De Moreuil
2   Inserm, UMR 1304 (GETBO), University of Brest, France
3   Internal Medicine, Vascular Medicine and Pneumology Department, CHU Brest, Brest, France
,
Cécile Tromeur
2   Inserm, UMR 1304 (GETBO), University of Brest, France
3   Internal Medicine, Vascular Medicine and Pneumology Department, CHU Brest, Brest, France
,
Emmanuelle Le Moigne
2   Inserm, UMR 1304 (GETBO), University of Brest, France
3   Internal Medicine, Vascular Medicine and Pneumology Department, CHU Brest, Brest, France
,
Pierre-Yves Le Roux
2   Inserm, UMR 1304 (GETBO), University of Brest, France
5   Department of Nuclear Medicine, CHU Brest, Brest, France
,
Francis Couturaud
2   Inserm, UMR 1304 (GETBO), University of Brest, France
3   Internal Medicine, Vascular Medicine and Pneumology Department, CHU Brest, Brest, France
› Author Affiliations Funding The study was supported by grants from the “Programme Hospitalier de Recherche Clinique” (French Department of Health), the Foundation “Archipel Santé” and the sponsor was the Brest Teaching Hospital. The funding source was not involved in designing or conducting the study, collecting, managing, analyzing, or interpreting the data, preparing, reviewing, or approving the manuscript, or deciding to submit this for publication. An academic steering committee led by F.C. assumed overall responsibility for all these steps.
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Abstract

Patients who had venous thromboembolism (VTE) are not only at increased risk of recurrent VTE but also of major adverse cardiovascular events (MACEs) than the general population. Therefore, the prediction of the risk of these events is important for a tailored prevention and mitigation strategy. We aimed to develop simple scores to estimate recurrent VTE and MACE risks after the discontinuation of anticoagulation in a large cohort of individuals who suffered VTE (EDITH cohort). The primary endpoints were recurrent symptomatic VTE and MACE (composite of non-fatal acute coronary syndrome, stroke and cardiovascular death). Arterial thrombotic event (ATE) exclusively was also considered. Independent predictors of main outcomes were derived from multivariable Cox regression models. Weighted integer points based on the effect estimate of identified predictors were used to derive the final risk scores. A total of 1,999 participants (mean age: 54.78 years, 46.4% male, 43.6% unprovoked VTE) were included in the derivation cohort and 10,000 in the validation cohort (built using bootstrapping). During a median post-anticoagulation follow-up of 6.9 years, recurrent VTE occurred in 29.5% of participants and MACE in 14.8%. Independent predictors of recurrent VTE were male sex, age >65 years, cancer-associated VTE, and unprovoked VTE (vs. transient risk factor-associated VTE). Independent predictors of MACE were age >65 years, cancer-associated VTE, hypertension, renal insufficiency, and atrial fibrillation. The risk of recurrent VTE (moderate vs. low: hazard ratio [HR]: 2.62, 95% confidence interval [CI]: 2.06–3.34; high vs. low: HR: 3.78, 95% CI: 2.91–4.89), MACE (moderate vs. low: HR: 6.37, 95% CI: 3.19–12.69; high vs. low: HR: 12.32, 95% CI: 6.09–24.89), and ATE (based on MACE-predict risk score) increased gradually from the lowest to highest of the respective prediction risk score groups. These results were confirmed in the validation cohort with overall reasonable models' discrimination performance (recurrent VTE C-statistic: 0.62–0.63, MACE and ATE C-statistic: 0.72–0.77). Contemporary simple risk scores based on readily available clinical characteristics can reasonably predict the risk of recurrent VTE and MACE after the discontinuation of anticoagulation. These findings may influence the choice of anticoagulation strategy after the acute phase of VTE and, therefore, need confirmation by further studies.

Keywords

venous thromboembolism - major adverse cardiovascular event - anticoagulation - prediction risk score - arterial cardiovascular event - R-VTE-predict - MACE-predict

Authors' Contributions

Conception and design: S.R.N., F.C. acquisition of data: F.C. Data analysis: S.R.N. Analysis and interpretation of data: S.R.N., F.C. Manuscript drafting: S.R.N. Manuscript revision: All authors. Approved the final version of the manuscript: All authors. Obtaining funding: F.C. Administrative technical and material support: F.C., C.T., R.D. Study supervision: F.C. Full access to all the data of the study: F.C., S.R.N. responsibility for all aspects of the study, reliability, and freedom from bias of the data presented: All authors.


Supplementary Material



Publication History

Article published online:
09 April 2025

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