Claims‐Based Score for the Prediction of Bleeding in a Contemporary Cohort of Patients Receiving Oral Anticoagulation for Venous Thromboembolism

Background Current scores for bleeding risk assessment in patients with venous thromboembolism (VTE) undergoing oral anticoagulation have limited predictive capacity. We developed and internally validated a bleeding prediction model using healthcare claims data. Methods and Results We selected patie...

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Autores principales:	Alvaro Alonso, Faye L. Norby, Richard F. MacLehose, Neil A. Zakai, Rob F. Walker, Terrence J. Adam, Pamela L. Lutsey
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	bleeding MarketScan oral anticoagulants prediction venous thromboembolism Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/59c9aec2f27e40a2a63fcb6d582946f1
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spelling	oai:doaj.org-article:59c9aec2f27e40a2a63fcb6d582946f12021-11-23T11:36:35ZClaims‐Based Score for the Prediction of Bleeding in a Contemporary Cohort of Patients Receiving Oral Anticoagulation for Venous Thromboembolism10.1161/JAHA.121.0212272047-9980https://doaj.org/article/59c9aec2f27e40a2a63fcb6d582946f12021-09-01T00:00:00Zhttps://www.ahajournals.org/doi/10.1161/JAHA.121.021227https://doaj.org/toc/2047-9980Background Current scores for bleeding risk assessment in patients with venous thromboembolism (VTE) undergoing oral anticoagulation have limited predictive capacity. We developed and internally validated a bleeding prediction model using healthcare claims data. Methods and Results We selected patients with incident VTE initiating oral anticoagulation in the 2011 to 2017 MarketScan databases. Hospitalized bleeding events were identified using validated algorithms in the 180 days after VTE diagnosis. We evaluated demographic factors, comorbidities, and medication use before oral anticoagulation initiation as potential predictors of bleeding using stepwise selection of variables in Cox models run on 1000 bootstrap samples of the patient population. Variables included in >60% of all models were selected for the final analysis. We internally validated the model using bootstrapping and correcting for optimism. We included 165 434 patients with VTE and initiating oral anticoagulation, of whom 2294 had a bleeding event. After undergoing the variable selection process, the final model included 20 terms (15 main effects and 5 interactions). The c‐statistic for the final model was 0.68 (95% CI, 0.67–0.69). The internally validated c‐statistic corrected for optimism was 0.68 (95% CI, 0.67–0.69). For comparison, the c‐statistic of the Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile International Normalized Ratio, Elderly (>65 Years), Drugs/Alcohol Concomitantly (HAS‐BLED) score in this population was 0.62 (95% CI, 0.61–0.63). Conclusions We have developed a novel model for bleeding prediction in VTE using large healthcare claims databases. Performance of the model was moderately good, highlighting the urgent need to identify better predictors of bleeding to inform treatment decisions.Alvaro AlonsoFaye L. NorbyRichard F. MacLehoseNeil A. ZakaiRob F. WalkerTerrence J. AdamPamela L. LutseyWileyarticlebleedingMarketScanoral anticoagulantspredictionvenous thromboembolismDiseases of the circulatory (Cardiovascular) systemRC666-701ENJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Vol 10, Iss 18 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	bleeding MarketScan oral anticoagulants prediction venous thromboembolism Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	bleeding MarketScan oral anticoagulants prediction venous thromboembolism Diseases of the circulatory (Cardiovascular) system RC666-701 Alvaro Alonso Faye L. Norby Richard F. MacLehose Neil A. Zakai Rob F. Walker Terrence J. Adam Pamela L. Lutsey Claims‐Based Score for the Prediction of Bleeding in a Contemporary Cohort of Patients Receiving Oral Anticoagulation for Venous Thromboembolism
description	Background Current scores for bleeding risk assessment in patients with venous thromboembolism (VTE) undergoing oral anticoagulation have limited predictive capacity. We developed and internally validated a bleeding prediction model using healthcare claims data. Methods and Results We selected patients with incident VTE initiating oral anticoagulation in the 2011 to 2017 MarketScan databases. Hospitalized bleeding events were identified using validated algorithms in the 180 days after VTE diagnosis. We evaluated demographic factors, comorbidities, and medication use before oral anticoagulation initiation as potential predictors of bleeding using stepwise selection of variables in Cox models run on 1000 bootstrap samples of the patient population. Variables included in >60% of all models were selected for the final analysis. We internally validated the model using bootstrapping and correcting for optimism. We included 165 434 patients with VTE and initiating oral anticoagulation, of whom 2294 had a bleeding event. After undergoing the variable selection process, the final model included 20 terms (15 main effects and 5 interactions). The c‐statistic for the final model was 0.68 (95% CI, 0.67–0.69). The internally validated c‐statistic corrected for optimism was 0.68 (95% CI, 0.67–0.69). For comparison, the c‐statistic of the Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile International Normalized Ratio, Elderly (>65 Years), Drugs/Alcohol Concomitantly (HAS‐BLED) score in this population was 0.62 (95% CI, 0.61–0.63). Conclusions We have developed a novel model for bleeding prediction in VTE using large healthcare claims databases. Performance of the model was moderately good, highlighting the urgent need to identify better predictors of bleeding to inform treatment decisions.
format	article
author	Alvaro Alonso Faye L. Norby Richard F. MacLehose Neil A. Zakai Rob F. Walker Terrence J. Adam Pamela L. Lutsey
author_facet	Alvaro Alonso Faye L. Norby Richard F. MacLehose Neil A. Zakai Rob F. Walker Terrence J. Adam Pamela L. Lutsey
author_sort	Alvaro Alonso
title	Claims‐Based Score for the Prediction of Bleeding in a Contemporary Cohort of Patients Receiving Oral Anticoagulation for Venous Thromboembolism
title_short	Claims‐Based Score for the Prediction of Bleeding in a Contemporary Cohort of Patients Receiving Oral Anticoagulation for Venous Thromboembolism
title_full	Claims‐Based Score for the Prediction of Bleeding in a Contemporary Cohort of Patients Receiving Oral Anticoagulation for Venous Thromboembolism
title_fullStr	Claims‐Based Score for the Prediction of Bleeding in a Contemporary Cohort of Patients Receiving Oral Anticoagulation for Venous Thromboembolism
title_full_unstemmed	Claims‐Based Score for the Prediction of Bleeding in a Contemporary Cohort of Patients Receiving Oral Anticoagulation for Venous Thromboembolism
title_sort	claims‐based score for the prediction of bleeding in a contemporary cohort of patients receiving oral anticoagulation for venous thromboembolism
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/59c9aec2f27e40a2a63fcb6d582946f1
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Claims‐Based Score for the Prediction of Bleeding in a Contemporary Cohort of Patients Receiving Oral Anticoagulation for Venous Thromboembolism

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