A prognostic score to identify low‐risk outpatients with acute deep vein thrombosis in the upper extremity

Abstract

for the RIETE Investigators. A prognostic score to identify low-risk outpatients with acute deep vein thrombosis in the upper extremity. J Thromb Haemost 2015; 13: 1274-8. Summary. Background:No studies have identified which patients with upper-extremity deep vein thrombosis (DVT) are at low risk for adverse events within the first week of therapy. Methods: We used data from Registro Informatizado de la Enfermedad TromboEmb olica to explore in patients with upper-extremity DVT a prognostic score that correctly identified patients with lower limb DVT at low risk for pulmonary embolism, major bleeding, or death within the first week. Results: As of December 2014, 1135 outpatients with upper-extremity DVT were recruited. Of these, 515 (45%) were treated at home. During the first week, three patients (0.26%) experienced pulmonary embolism, two (0.18%) had major bleeding, and four (0.35%) died. We assigned 1 point to patients with chronic heart failure, creatinine clearance levels 30-60 mL min À1 , recent bleeding, abnormal platelet count, recent immobility, or cancer without metastases; 2 points to those with metastatic cancer; and 3 points to those with creatinine clearance levels < 30 mL min À1. Overall, 759 (67%) patients scored ≤ 1 point and were considered to be at low risk. The rate of the composite outcome within the first week was 0.26% (95% confidence interval [CI] 0.004-0.87) in patients at low risk and 1.86% (95% CI 0.81-3.68) in the remaining patients. C-statistics was 0.73 (95% CI 0.57-0.88). Net reclassification improvement was 22%, and integrated discrimination improvement was 0.0055. Conclusions: Using six easily available variables, we identified outpatients with upper-extremity DVT at low risk for adverse events within the first week. These data may help to safely treat more patients at home.

Diagnosis and management of acute deep vein thrombosis: a joint consensus document from the European Society of Cardiology working groups of aorta and peripheral vascular diseases and pulmonary circulation and right ventricular function

“…A prognostic score identifying low-risk DVT patients who could be safely treated at home has been proposed but not yet externally validated. 101 Deep vein thrombosis at unusual sites Cerebral vein thrombosis Most common cerebral vein thrombosis (CVT) presentation includes severe headaches, seizures, focal neurological deficits, and altered consciousness. 102,103 For the diagnosis and treatment refer to the Supplementary material online, only section.…”

Systematic Review of Real-World Studies Evaluating Characteristics Associated With or Programs Designed to Facilitate Outpatient Management of Deep Vein Thrombosis

“…This left 21 real-world studies evaluating clinical characteristics associated with or programs designed to facilitate outpatient DVT treatment to be included in our systematic review (Table 1). 4,8 -10,14 -37…”

A clinical decision framework to guide the outpatient treatment of emergency department patients diagnosed with acute pulmonary embolism or deep vein thrombosis: Results from a multidisciplinary consensus panel

“…Many ED patients with acute DVT are eligible for home treatment, including those with upper extremity DVT 64–66 . Psychosocial features conducive to outpatient treatment should be in place, as described.…”