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Predicting international normalised ratio ≥ 4.5 in hospitalised patients using vitamin K antagonists
Vitamin K antagonists (VKAs) used for the prevention and treatment of thromboembolic disease, increase the risk of bleeding complications. This model was developed and validated to predict the risk of an international normalised ratio (INR) ≥4.5 during a hospital stay.
We developed and validated a clinical prediction model for an INR ≥4.5 in VKA-treated patients admitted to our hospital. The model includes factors that are collected during routine care and are extractable from electronic patient records, enabling easy use of this model to predict an increased bleeding
risk in clinical practice.
We developed and validated a clinical prediction model for an INR ≥4.5 in VKA-treated patients admitted to our hospital. The model includes factors that are collected during routine care and are extractable from electronic patient records, enabling easy use of this model to predict an increased bleeding
risk in clinical practice.
Research authors: Albert R. Dreijer, Joseph S. Biedermann, Jeroen Diepstraten, Anouk D. Lindemans, Marieke J.H.A. Kruip, Patricia M.L.A. van den Bemt, Yvonne Vergouwe
Details
Formula
Study characteristics
Files & References
★★★★
Model author
Model ID
1221
Version
1.9
Revision date
2018-03-20
Specialty
MeSH terms
Model type
Logistic regression
(Calculation)
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Additional information
Adult patients admitted to a tertiary hospital and treated with VKAs between 2006 and 2010 were analysed. Bleeding risk was operationalised as an INR value ≥4.5. Multivariable logistic regression analysis was used to assess the association between potential predictors and an INR ≥4.5 and validated in an independent cohort of patients from the same hospital between 2011 and 2014.8996 admissions of patients treated with VKAs were identified, of which 1507 (17%) involved an INR ≥4.5. The final model included the following predictors: gender, age, concomitant medication and several biochemical parameters. Temporal validation showed a c-statistic of 0.71.
The development cohort constisted of 8996 patients, and the validation cohort consisted of 9018 patients.
Study Population
Total population size: 8996Males: {{ model.numberOfMales }}
Females: {{ model.numberOfFemales }}
Continuous characteristics
| Name | LL | Q1 | Median | Q3 | UL | Unit |
|---|---|---|---|---|---|---|
| Alanine amino transferase | 16 | 25 | 44 | u/l | ||
| Aspartate amino transferase | 22 | 30 | 44 | u/l | ||
| Gamma-glutamyl transferase | 33 | 61 | 131 | u/l | ||
| Lactate dehydrogenase | 357 | 442.5 | 589.8 | u/l | ||
| Albumin | 31 | 36 | 41 | g/l | ||
| estimated Glomerular filtration rate | 49 | 70 | 90 | ml/min/1.73m2 | ||
| Haemoglobin | 100 | 116 | 134 | g/l | ||
| Thyroid stimulation hormone | 0.7 | 1.4 | 2.8 | mu/l | ||
| Triiodothyronine | 1.0 | 1.4 | 1.8 | nmol/l | ||
| Thyroxin | 83.5 | 104.5 | 132.0 | nmol/l | ||
| C-reactive protein | 8 | 30 | 82 | mg/l | ||
| plateletcount | 175 | 229 | 300.8 | x10^9/l |
Categorical characteristics
| Name | Subset / Group | Nr. of patients |
|---|---|---|
| INR ≥4.5 during a previous admission | Yes | 868 |
| No | 8128 | |
| VKA type | acenocoumarol | 7978 |
| Other | 1018 | |
| Ward type | Medical ward | 5497 |
| Ither | 3499 | |
| Use of concomitant medication | Miconazole | 153 |
| Cotrimoxazole | 337 | |
| Fluconazole | 119 | |
| Voriconazole | 7 | |
| Amiodarone | 724 | |
| Rifampicin | 53 | |
| Carbamazepine | 73 | |
| Phenytoin | 89 | |
| Colestyramin | 17 | |
| Anti-thyroid drugs | 110 |
Related files
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Supporting Publications
| Title or description | Tags |
|---|---|
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Development of a clinical prediction model for an international normalized ratio ≥4.5 in hospitalized patients using vitamin K antagonists
DOI:
10.1111/bjh.15161
|
External validation Internal validation Paper Peer review |
Predicted risk of INR ≥ 4.5 ...
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Predicted risk of INR ≥ 4.5
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Result interpretation
The prediction model can help physicians to identify patients at the lower spectrum of thromboembolic risk and those for whom the risk of bleeding during vitamin K antagonist (VKA) therapy is high. Using the prediction model may also help
when counselling and informing patients about their potential risk for haemorrhage while on anticoagulants, and in identifying those patients who might benefit from more careful management of anticoagulation. Alternatively, these patients can also be switched to direct oral anticoagulants (DOACs), which cause less major bleeding, such as intracranial haemorrhages, compared to VKAs
Calculations alone should never dictate patient care, and are no substitute for professional judgement. See our full disclaimer.
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Disclaimer: Calculations alone should never dictate patient care, and are no substitute for professional judgement.
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