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Letter to the Editors-in-Chief| Volume 224, P17-20, April 2023

The value of the CHAP model for prediction of the bleeding risk in patients with unprovoked venous thromboembolism: Findings from the RIETE registry

Published:February 13, 2023DOI:https://doi.org/10.1016/j.thromres.2023.02.006
The value of the CHAP model for prediction of the bleeding risk in patients with unprovoked venous thromboembolism: Findings from the RIETE registry
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      The decision as to prolong or discontinue anticoagulation beyond the first three months in patients with unprovoked venous thromboembolism (VTE) is generally made after a balance between the expected risk of recurrent VTE and that of major bleeding complications. Indeed, based on the results of recent comprehensive overviews and meta-analyses of several cohorts, the 5-year cumulative incidence of recurrent VTE after stopping anticoagulation is expected to achieve 25 % [
      • Khan F.
      • Rahman A.
      • Carrier M.
      • Kearon C.
      • Weitz J.I.
      • Schulman S.
      • Couturaud F.
      • Eichinger S.
      • Kyrle P.A.
      • Becattini C.
      • Agnelli G.
      • Brighton T.A.
      • Lensing A.W.A.
      • Prins M.H.
      • Sabri E.
      • Hutton B.
      • Pinede L.
      • Cushman M.
      • Palareti G.
      • Wells G.A.
      • Prandoni P.
      • Büller H.R.
      • Rodger M.A.
      Long term risk of symptomatic recurrent venous thromboembolism after discontinuation of anticoagulant treatment for first unprovoked venous thromboembolism event: systematic review and meta-analysis.
      Br. Med. J. 2019; 366l4363
      ], and that of major bleeding complications in candidates to extended anticoagulation with vitamin K antagonists (VKA) is as high as 6.3 %, the 95 % confidence intervals (CI) around this rate achieving 10 % [
      • Khan F.
      • Tritschler T.
      • Kimpton M.
      • Wells P.S.
      • Kearon C.
      • Weitz J.I.
      • Büller H.R.
      • Raskob G.E.
      • Ageno W.
      • Couturaud F.
      • Prandoni P.
      • Palareti G.
      • Legnani C.
      • Kyrle P.A.
      • Eichinger S.
      • Eischer L.
      • Becattini C.
      • Agnelli G.
      • Vedovati M.C.
      • Geersing G.J.
      • Takada T.
      • Cosmi B.
      • Aujesky D.
      • Marconi L.
      • Palla A.
      • Siragusa S.
      • Bradbury C.A.
      • Parpia S.
      • Mallick R.
      • Lensing A.W.A.
      • Gebel M.
      • Grosso M.A.
      • Thavorn K.
      • Hutton B.
      • Le Gal G.
      • Fergusson D.A.
      • Rodger M.A.
      Long-term risk for major bleeding during extended oral anticoagulant therapy for first unprovoked venous thromboembolism: a systematic review and meta-analysis.
      Ann. Intern. Med. 2021; 174: 1420-1429
      ]. Although the rate of major bleeding complications is definitely lower among patients managed with direct oral anticoagulants (DOAC), it is not negligible, and the case-fatality rate is fully consistent with that observed in patients managed with VKA [
      • Khan F.
      • Tritschler T.
      • Kimpton M.
      • Wells P.S.
      • Kearon C.
      • Weitz J.I.
      • Büller H.R.
      • Raskob G.E.
      • Ageno W.
      • Couturaud F.
      • Prandoni P.
      • Palareti G.
      • Legnani C.
      • Kyrle P.A.
      • Eichinger S.
      • Eischer L.
      • Becattini C.
      • Agnelli G.
      • Vedovati M.C.
      • Geersing G.J.
      • Takada T.
      • Cosmi B.
      • Aujesky D.
      • Marconi L.
      • Palla A.
      • Siragusa S.
      • Bradbury C.A.
      • Parpia S.
      • Mallick R.
      • Lensing A.W.A.
      • Gebel M.
      • Grosso M.A.
      • Thavorn K.
      • Hutton B.
      • Le Gal G.
      • Fergusson D.A.
      • Rodger M.A.
      Long-term risk for major bleeding during extended oral anticoagulant therapy for first unprovoked venous thromboembolism: a systematic review and meta-analysis.
      Ann. Intern. Med. 2021; 174: 1420-1429
      ].

      Keywords

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      Article info

      Publication history

      Published online: February 13, 2023
      Accepted: February 10, 2023
      Received in revised form: January 23, 2023
      Received: December 17, 2022

      Identification

      DOI: https://doi.org/10.1016/j.thromres.2023.02.006

      Copyright

      Published by Elsevier Ltd.

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