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Evaluation of Venous Thromboembolism Recurrence Scores in an Unprovoked Pulmonary Embolism Population: a post-hoc analysis of the PADIS-PE trial

Abstract : INTRODUCTION We aimed to validate the HERDOO2 DASH and Updated Vienna recurrent venous thromboembolism prediction models in a population composed entirely of first unprovoked pulmonary embolism and analyzed the impact of the addition of pulmonary vascular obstruction index (PVOI) on score accuracy. METHODS Analyses were based on the double-blind randomized PADIS-PE trial including 371 unprovoked pulmonary embolism patients initially treated during 6 months successively randomized to receive an additional 18-months of warfarin or placebo and subsequently followed-up for two years. RESULTS The HERDOO2 DASH and Updated Vienna scores displayed c-statistics of 0.61 (95%CI 0.54-0.68) 0.60 (95%CI 0.53-0.66) and 0.58 (95%CI 0.51-0.66) respectively. Only the HERDOO2 score identified low recurrence risk patients (<3%/year) after stopping anticoagulation. When added to either of the prediction models PVOI measured at pulmonary embolism diagnosis and/or after 6 months of anticoagulation improved scores' c-statistics between +0.06 and +0.11 points and consistently led to identifying at least 50% of patients who experienced recurrence but in whom the scores would have indicated against extended anticoagulation. CONCLUSIONS In patients with a first unprovoked pulmonary embolism the HERDOO2 score is able to identify patients with a low recurrence risk after treatment discontinuation. Addition of PVOI improves accuracy of all scores. CLINICAL TRIALS REGISTRATION URL http//www.controlled-trials.com. Unique identifier NCT00740883.
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Submitted on : Thursday, May 28, 2020 - 2:05:46 PM
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L Raj, E Presles, R Le Mao, P Robin, O Sanchez, et al.. Evaluation of Venous Thromboembolism Recurrence Scores in an Unprovoked Pulmonary Embolism Population: a post-hoc analysis of the PADIS-PE trial. The American Journal of Medicine, Elsevier [Commercial Publisher] In press, ⟨10.1016/j.amjmed.2020.03.040⟩. ⟨hal-02639290⟩

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