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Systematic review of prognostic models for recurrent venous thromboembolism (VTE) post-treatment of first unprovoked VTE
  1. Joie Ensor1,
  2. Richard D Riley1,
  3. David Moore2,
  4. Kym I E Snell2,
  5. Susan Bayliss2,
  6. David Fitzmaurice3
  1. 1Research Institute of Primary Care and Health Sciences, Keele University, Staffordshire, UK
  2. 2Public Health, Epidemiology and Biostatistics, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
  3. 3Primary Care Clinical Sciences, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
  1. Correspondence to Joie Ensor; j.ensor{at}


Objectives To review studies developing or validating a prognostic model for individual venous thromboembolism (VTE) recurrence risk following cessation of therapy for a first unprovoked VTE. Prediction of recurrence risk is crucial to informing patient prognosis and treatment decisions. The review aims to determine whether reliable prognostic models exist and, if not, what further research is needed within the field.

Design Bibliographic databases (including MEDLINE, EMBASE and the Cochrane Library) were searched using index terms relating to the clinical field and prognosis. Screening of titles, abstracts and subsequently full texts was conducted by 2 reviewers independently using predefined criteria. Quality assessment and critical appraisal of included full texts was based on an early version of the PROBAST (Prediction study Risk Of Bias Assessment Tool) for risk of bias and applicability in prognostic model studies.

Setting Studies in any setting were included.

Primary and secondary outcome measures The primary outcome for the review was the predictive accuracy of identified prognostic models in relation to VTE recurrence risk.

Results 3 unique prognostic models were identified including the HERDOO2 score, Vienna prediction model and DASH score. Quality assessment highlighted the Vienna, and DASH models were developed with generally strong methodology, but the HERDOO2 model had many methodological concerns. Further, all models were considered at least at moderate risk of bias, primarily due to the need for further external validation before use in practice.

Conclusions Although the Vienna model shows the most promise (based on strong development methodology, applicability and having some external validation), none of the models can be considered ready for use until further, external and robust validation is performed in new data. Any new models should consider the inclusion of predictors found to be consistently important in existing models (sex, site of index event, D-dimer), and take heed of several methodological issues identified through this review.

PROSPERO registration number CRD42013003494.

  • Venous thrombosis
  • Recurrence risk
  • Prognostic model
  • Prediction model

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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