Affiliation:
1. Department of Epidemiology Rollins School of Public Health Emory University Atlanta GA
2. Center for Cardiac Arrest Prevention Department of Cardiology Cedars‐Sinai Smidt Heart Institute Los Angeles CA
3. Division of Epidemiology and Community Health School of Public Health University of Minnesota Minneapolis MN
4. Division of Hematology/Oncology Department of Medicine and Department of Pathology and Laboratory Medicine Larner College of Medicine at the University of Vermont Burlington VT
5. Department of Pharmaceutical Care and Health Systems College of Pharmacy University of Minnesota Minneapolis MN
Abstract
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.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
3 articles.
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