New tool aims to cut unnecessary blood thinners after blood clots
Researchers across Europe are building a decision-support system to help doctors and patients decide when to stop long-term anticoagulant therapy after unprovoked blood clots. The tool combines medical data with patient preferences—addressing a major gap where current guidelines push most patients toward indefinite treatment despite evidence that many face unnecessary bleeding risk.
Originaltitel: Prognosis Prediction and Shared Decision Making for Personalised Anticoagulant Therapy after Unprovoked Venous Thromboembolism: The MORPHEUS project.
Personaliserad långtidsantikoagulering efter oprovocerad ventrombembolism kan minska onödiga blödningar och öka patientöverenskommelse genom bättre riskstratifiering. MORPHEUS-projektet utvecklar tidsberoendeprognossystem som kombinerar kliniska, biologiska och radiologiska biomarkörer med patienternas egna upplevelser och preferenser. Det åttaeuropeiska forskningskonsortiet använder maskinlärning på stora prospektiva kohorter för att bygga prediktionsmodeller för återfallstromber och blödningskomplikationer. En randomiserad studie med 2 400 patienter utvärderar hur integrationen i ett gemensamt beslutfattande påverkar behandlingseffektivitet och acceptans. Projektet siktar på att reducera överbehandling, sänka blödningsrisk och förbättra behandlingsöverenskommelse. För inköpschefer och chefsläkare blir detta verktyg relevant när det valideras; det möjliggör evidensbaserad dosering som minskar antikoagulantskomplikationer och förlänger antitrombotisk säkerhet. Resultat förväntas 2026.
Background In patients with unprovoked venous thromboembolism (VTE), indefinite anticoagulation is recommended to prevent recurrence but may expose some patients to unnecessary long-term bleeding risk. Current clinical scores and biomarkers have limited discriminative performance, do not capture the time-dependent nature of VTE, and do not incorporate patients' perspectives or support shared decision-making. Objectives To develop and validate time-dependent, multicomponent risk prediction scores and socio-anthropological scales (TDMI) integrated in a shared decision-making process to optimise long-term anticoagulation management after unprovoked VTE. Patients/Methods MORPHEUS is an international, multidisciplinary research program conducted in eight European countries. The TDMI will combine clinical, biological, imaging, and pharmacological biomarkers with socio-anthropological scales reflecting patients' lived experiences, preferences, and perceptions of risk. Candidate components will be identified through systematic literature review, Delphi consensus, qualitative interviews with patients and physicians, and pooled analyses of large prospective European VTE cohorts including clinical outcomes, biobanks, and imaging data. Dynamic, multilevel, time-dependent prediction models for recurrent VTE and anticoagulant-related bleeding will be derived using advanced statistical and machine-learning approaches. The clinical effectiveness and acceptability of TDMI integrated in a shared decision-making process will be evaluated in a stepped-wedge cluster randomised trial enrolling 2,400 patients with a first unprovoked VTE. Expected results The TDMI is expected to improve individualized risk stratification, reduce unnecessary extended anticoagulation, lower bleeding complications, and improve patient satisfaction, treatment adherence, and quality of life. Conclusions The MORPHEUS project will support personalised anticoagulation decisions and improve long-term outcomes in patients after unprovoked VTE.