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Development and validation of risk prediction model for venous thromboembolism in postpartum women: multinational cohort study

BMJ (Online), 2016-12, Vol.355 (8085), p.i6253-i6253 [Peer Reviewed Journal]

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to ;Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions. ;Copyright: 2016 Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions ;Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to 2016 BMJ ;ISSN: 1756-1833 ;ISSN: 0959-8138 ;EISSN: 1756-1833 ;DOI: 10.1136/bmj.i6253 ;PMID: 27919934

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Title:
Development and validation of risk prediction model for venous thromboembolism in postpartum women: multinational cohort study
Author: Sultan, Alyshah Abdul ; West, Joe ; Grainge, Matthew J ; Riley, Richard D ; Tata, Laila J ; Stephansson, Olof ; Fleming, Kate M ; Nelson-Piercy, Catherine ; Ludvigsson, Jonas F
Subjects: Adult ; Algorithms ; Cesarean Section - statistics & numerical data ; Cohort Studies ; Comorbidity ; Eclampsia - epidemiology ; Embolisms ; Emergencies - epidemiology ; England - epidemiology ; Female ; Gynecology ; Health risk assessment ; Hip joint ; Hospitals ; Humans ; Logistic Models ; Maternal mortality ; Medicin och hälsovetenskap ; Multivariate Analysis ; Patients ; Population ; Postpartum ; Postpartum period ; Pre-eclampsia ; Pre-Eclampsia - epidemiology ; Pregnancy ; Primary care ; Puerperal Disorders - epidemiology ; Puerperal Infection - epidemiology ; Pulmonary Embolism - epidemiology ; Risk Assessment ; Risk Factors ; Statistical analysis ; Stillbirth ; Stillbirth - epidemiology ; Sweden - epidemiology ; Thromboembolism ; Thrombosis ; Varicose Veins - epidemiology ; Veins ; Venous Thromboembolism - epidemiology ; Venous Thrombosis - epidemiology ; Womens health ; Young Adult
Is Part Of: BMJ (Online), 2016-12, Vol.355 (8085), p.i6253-i6253
Description: Objective To develop and validate a risk prediction model for venous thromboembolism in the first six weeks after delivery (early postpartum).Design Cohort study.Setting Records from England based Clinical Practice Research Datalink (CPRD) linked to Hospital Episode Statistics (HES) and data from Sweden based registry.Participants All pregnant women registered with CPRD-HES linked data between 1997 and 2014 and Swedish medical birth registry between 2005 and 2011 with postpartum follow-up.Main outcome measure Multivariable logistic regression analysis was used to develop a risk prediction model for postpartum venous thromboembolism based on the English data, which was externally validated in the Swedish data.Results 433 353 deliveries were identified in the English cohort and 662 387 in the Swedish cohort. The absolute rate of venous thromboembolism was 7.2 per 10 000 deliveries in the English cohort and 7.9 per 10 000 in the Swedish cohort. Emergency caesarean delivery, stillbirth, varicose veins, pre-eclampsia/eclampsia, postpartum infection, and comorbidities were the strongest predictors of venous thromboembolism in the final multivariable model. Discrimination of the model was similar in both cohorts, with a C statistic above 0.70, with excellent calibration of observed and predicted risks. The model identified more venous thromboembolism events than the existing national English (sensitivity 68% v 63%) and Swedish guidelines (30% v 21%) at similar thresholds.Conclusion A new prediction model that quantifies absolute risk of postpartum venous thromboembolism has been developed and externally validated. It is based on clinical variables that are available in many developed countries at the point of delivery and could serve as the basis for real time decisions on obstetric thromboprophylaxis.
Publisher: England: BMJ Publishing Group LTD
Language: English
Identifier: ISSN: 1756-1833
ISSN: 0959-8138
EISSN: 1756-1833
DOI: 10.1136/bmj.i6253
PMID: 27919934
Source: BMJ Open Access Journals
MEDLINE
SWEPUB Freely available online
ProQuest Central

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Development and validation of risk prediction model for venous thromboembolism in postpartum women: multinational cohort study

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