Developing a model for predicting venous thromboembolism in obese pregnant women in a national study

Ellis-Kahana, Julia; Sparks, Andrew; Gimovsky, Alexis C.; James, Andra H.; Ahmadzia, Homa K.

doi:10.1016/j.thromres.2020.03.025

Cited by 11 publications

(30 citation statements)

References 19 publications

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“…The remaining studies focused on external validation with no description of the initial derivation methodology 23–34 36–38. Due to the lack of model derivation studies with external validation, we also identified and included one internal validation study for completeness (ie, prediction model development without external validation) 39. This study used a bootstrap validation approach to capture optimism in model performance40 41 when applied to similar future patients.…”

Section: Resultsmentioning

confidence: 99%

“…The design and participant characteristics of the 17 included studies are summarised in table 1. All studies were published between 2000 and 2020 and were undertaken in North America (n=4),24 37–39 Southeast Asia (n=1),33 Europe (n=10),23 25–30 32 34 36 South America (n=1)31 and one study was multicountry 35. Sample sizes ranged from 5231 to 662 38735 patients in 14 observational cohort studies (6 prospective25 27 28 31 33 36 (all single centre) and 8 retrospective24 26 29 30 34 35 37 39 [2 of which were multicentre] in design).…”

Section: Resultsmentioning

confidence: 99%

“…The studies included in this review evaluated 19 externally validated RAMs [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] and 1 internally validated risk model. 39 While most RAMs focused solely on the estimate of thromboembolic risk, RAMs varied in design, structure, threshold, dosage and duration for pharmacological prophylaxis. In addition, the individual predictors and their weighting varied markedly between RAMs.…”

Section: Ramsmentioning

confidence: 99%

“…In addition, their model lacked some important VTE risk factors (eg, thrombophilia, antepartum immobilisation), and possibly underestimated the risks due to diagnosis limited to diagnostic coding (eg, varicose veins, severity of comorbidities) and the use of thromboprophylaxis in both cohorts. 42 Ellis-Kahana et al, 39 also derived (using a large national database from the USA) a risk prediction model for VTE in obese pregnant women and indicated strong discrimination. However, this model still requires external validation.…”

Section: Comparison To the Existing Literaturementioning

confidence: 99%

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Risk assessment models for venous thromboembolism in pregnancy and in the puerperium: a systematic review

et al. 2022

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ObjectivesTo assess the comparative accuracy of risk assessment models (RAMs) to identify women during pregnancy and the early postnatal period who are at increased risk of venous thromboembolism (VTE).DesignSystematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Data sourcesMEDLINE, Embase, Cochrane Library and two research registers were searched until February 2021.Eligibility criteriaAll validation studies that examined the accuracy of a multivariable RAM (or scoring system) for predicting the risk of developing VTE in women who are pregnant or in the puerperium (within 6 weeks post-delivery).Data extraction and synthesisTwo authors independently selected and extracted data. Risk of bias was appraised using PROBAST (Prediction model Risk Of Bias ASsessment Tool). Data were synthesised without meta-analysis.ResultsSeventeen studies, comprising 19 externally validated RAMs and 1 internally validated model, met the inclusion criteria. The most widely evaluated RAMs were the Royal College of Obstetricians and Gynaecologists guidelines (six studies), American College of Obstetricians and Gynecologists guidelines (two studies), Swedish Society of Obstetrics and Gynecology guidelines (two studies) and the Lyon score (two studies). In general, estimates of sensitivity and specificity were highly variable with sensitivity estimates ranging from 0% to 100% for RAMs that were applied to antepartum women to predict antepartum or postpartum VTE and 0% to 100% for RAMs applied postpartum to predict postpartum VTE. Specificity estimates were similarly diverse ranging from 28% to 98% and 5% to 100%, respectively.ConclusionsAvailable data suggest that external validation studies have weak designs and limited generalisability, so estimates of prognostic accuracy are very uncertain.PROSPERO registration numberCRD42020221094.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Ramsmentioning

confidence: 99%

Section: Comparison To the Existing Literaturementioning

confidence: 99%

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Risk assessment models for venous thromboembolism in pregnancy and in the puerperium: a systematic review

et al. 2022

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“…This suggests that variables specific to pregnancy and known to increase VTE risk—such as pre-eclampsia, endometritis and placenta previa—are omitted from commonly used RAMs, making them less applicable in the obstetric population. 15…”

Section: What Rams Are Currently In Use? What Are Their Pitfalls?mentioning

confidence: 99%

Venous Thromboembolism Risk Assessment Models in Obstetrics: A Review of Current Practices and Future Directions

et al. 2022

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Pregnancy is a major risk factor for venous thromboembolism (VTE) and its associated complications. The hypercoagulable state in both the antenatal and postnatal periods contributes to thromboembolism and continues to be a leading cause of maternal morbidity and mortality worldwide. The non-specific signs and symptoms of VTE in pregnancy and the lack of specific Risk Assessment Models (RAMs) propose a diagnostic challenge in the obstetric population. This review aims to discuss and compare existing RAMs and highlights the important challenges of using established RAMs in obstetric patients. It also emphasizes the importance of enhancing and individualizing RAMs in obstetrics to improve maternal healthcare.

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Venous thromboembolism prophylaxis for women at risk during pregnancy and the early postnatal period

Middleton

Shepherd

Gomersall

2021

Cochrane Database of Systematic Reviews

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Developing a model for predicting venous thromboembolism in obese pregnant women in a national study

Cited by 11 publications

References 19 publications

Risk assessment models for venous thromboembolism in pregnancy and in the puerperium: a systematic review

Risk assessment models for venous thromboembolism in pregnancy and in the puerperium: a systematic review

Venous Thromboembolism Risk Assessment Models in Obstetrics: A Review of Current Practices and Future Directions

Venous thromboembolism prophylaxis for women at risk during pregnancy and the early postnatal period

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