External validation and updating of prediction models of bleeding risk in patients with cancer receiving anticoagulants
Objective Patients with cancer are at increased bleeding risk, and anticoagulants increase this risk even more. Yet, validated bleeding risk models for prediction of bleeding risk in patients with cancer are lacking. The aim of this study is to predict bleeding risk in anticoagulated patients with c...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-04-01
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| Series: | Open Heart |
| Online Access: | https://openheart.bmj.com/content/10/1/e002273.full |
| _version_ | 1797847371912052736 |
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| author | FH Rutten M van Smeden EM Trinks-Roerdink GJ Geersing MEW Hemels IC van Gelder FA Klok S van Doorn |
| author_facet | FH Rutten M van Smeden EM Trinks-Roerdink GJ Geersing MEW Hemels IC van Gelder FA Klok S van Doorn |
| author_sort | FH Rutten |
| collection | DOAJ |
| description | Objective Patients with cancer are at increased bleeding risk, and anticoagulants increase this risk even more. Yet, validated bleeding risk models for prediction of bleeding risk in patients with cancer are lacking. The aim of this study is to predict bleeding risk in anticoagulated patients with cancer.Methods We performed a study using the routine healthcare database of the Julius General Practitioners’ Network. Five bleeding risk models were selected for external validation. Patients with a new cancer episode during anticoagulant treatment or those initiating anticoagulation during active cancer were included. The outcome was the composite of major bleeding and clinically relevant non-major (CRNM) bleeding. Next, we internally validated an updated bleeding risk model accounting for the competing risk of death.Results The validation cohort consisted of 1304 patients with cancer, mean age 74.0±10.9 years, 52.2% males. In total 215 (16.5%) patients developed a first major or CRNM bleeding during a mean follow-up of 1.5 years (incidence rate; 11.0 per 100 person-years (95% CI 9.6 to 12.5)). The c-statistics of all selected bleeding risk models were low, around 0.56. Internal validation of an updated model accounting for death as competing risk showed a slightly improved c-statistic of 0.61 (95% CI 0.54 to 0.70). On updating, only age and a history of bleeding appeared to contribute to the prediction of bleeding risk.Conclusions Existing bleeding risk models cannot accurately differentiate bleeding risk between patients. Future studies may use our updated model as a starting point for further development of bleeding risk models in patients with cancer. |
| first_indexed | 2024-04-09T18:10:21Z |
| format | Article |
| id | doaj.art-9f623f049bf3472b8c31be31d3798081 |
| institution | Directory Open Access Journal |
| issn | 2053-3624 |
| language | English |
| last_indexed | 2024-04-09T18:10:21Z |
| publishDate | 2023-04-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Open Heart |
| spelling | doaj.art-9f623f049bf3472b8c31be31d37980812023-04-13T21:30:06ZengBMJ Publishing GroupOpen Heart2053-36242023-04-0110110.1136/openhrt-2023-002273External validation and updating of prediction models of bleeding risk in patients with cancer receiving anticoagulantsFH Rutten0M van Smeden1EM Trinks-Roerdink2GJ Geersing3MEW Hemels4IC van Gelder5FA Klok6S van Doorn7Department of General Practice & Nursing Science, Julius Centre for Health Sciences and Primary Care, UMCU, Utrecht, The NetherlandsDepartment of Epidemiology & Health Economics, Julius Centre for Health Sciences and Primary Care, UMCU, Utrecht, The NetherlandsDepartment of General Practice & Nursing Science, Julius Centre for Health Sciences and Primary Care, UMCU, Utrecht, The NetherlandsDepartment of General Practice & Nursing Science, Julius Centre for Health Sciences and Primary Care, UMCU, Utrecht, The NetherlandsDepartment of Cardiology, Rijnstate Hospital, Arnhem, The NetherlandsDepartment of Cardiology, UMCG, Groningen, The NetherlandsDepartment of Medicine - Thrombosis and Haemostasis, LUMC, Leiden, The NetherlandsDepartment of General Practice & Nursing Science, Julius Centre for Health Sciences and Primary Care, UMCU, Utrecht, The NetherlandsObjective Patients with cancer are at increased bleeding risk, and anticoagulants increase this risk even more. Yet, validated bleeding risk models for prediction of bleeding risk in patients with cancer are lacking. The aim of this study is to predict bleeding risk in anticoagulated patients with cancer.Methods We performed a study using the routine healthcare database of the Julius General Practitioners’ Network. Five bleeding risk models were selected for external validation. Patients with a new cancer episode during anticoagulant treatment or those initiating anticoagulation during active cancer were included. The outcome was the composite of major bleeding and clinically relevant non-major (CRNM) bleeding. Next, we internally validated an updated bleeding risk model accounting for the competing risk of death.Results The validation cohort consisted of 1304 patients with cancer, mean age 74.0±10.9 years, 52.2% males. In total 215 (16.5%) patients developed a first major or CRNM bleeding during a mean follow-up of 1.5 years (incidence rate; 11.0 per 100 person-years (95% CI 9.6 to 12.5)). The c-statistics of all selected bleeding risk models were low, around 0.56. Internal validation of an updated model accounting for death as competing risk showed a slightly improved c-statistic of 0.61 (95% CI 0.54 to 0.70). On updating, only age and a history of bleeding appeared to contribute to the prediction of bleeding risk.Conclusions Existing bleeding risk models cannot accurately differentiate bleeding risk between patients. Future studies may use our updated model as a starting point for further development of bleeding risk models in patients with cancer.https://openheart.bmj.com/content/10/1/e002273.full |
| spellingShingle | FH Rutten M van Smeden EM Trinks-Roerdink GJ Geersing MEW Hemels IC van Gelder FA Klok S van Doorn External validation and updating of prediction models of bleeding risk in patients with cancer receiving anticoagulants Open Heart |
| title | External validation and updating of prediction models of bleeding risk in patients with cancer receiving anticoagulants |
| title_full | External validation and updating of prediction models of bleeding risk in patients with cancer receiving anticoagulants |
| title_fullStr | External validation and updating of prediction models of bleeding risk in patients with cancer receiving anticoagulants |
| title_full_unstemmed | External validation and updating of prediction models of bleeding risk in patients with cancer receiving anticoagulants |
| title_short | External validation and updating of prediction models of bleeding risk in patients with cancer receiving anticoagulants |
| title_sort | external validation and updating of prediction models of bleeding risk in patients with cancer receiving anticoagulants |
| url | https://openheart.bmj.com/content/10/1/e002273.full |
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