Enoxaparin versus Placebo to Prevent Symptomatic Venous Thromboembolism in Hospitalized Older Adult Medical Patients

Mottier, Dominique; Girard, Philippe; Couturaud, F.; Lacut, Karine; Moigne, Emmanuelle Le; Paleiron, Nicolas; Guellec, Dewi; Sanchez, Olivier; Cogulet, Virginie; Laporte, Silvy; Marhic, Gisèle; Mismetti, Patrick; Presles, Émilie; Robert‐Ebadi, Helia; Mahé, Isabelle; Plaisance, Ludovic; Reny, Jean‐Luc; Farhoumand, Pauline Darbellay; Cuvelier, Clémence; Hénaff, Catherine Le; Lambert, Yannick; Déserts, Marc Danguy des; Legrand, Catherine; Boutreux, S.; Bléher, Yves; Decours, Romain; Trinh-Duc, Albert; Armengol, G.; Benhamou, Y.; Daumas, Aurélie; Guyot, Sarah-Lou; Carvalho, Hugo De; Lamia, Bouchra; Righini, Marc; Meyer, Guy; Gal, Grégoire Le

doi:10.1056/evidoa2200332

Cited by 9 publications

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“… 6 , 36 , 37 The recently published SYMPTOMS (Systematic Elderly Medical Patients Thromboprophylaxis: Efficacy on Symptomatic Outcomes) trial did not show significant differences in symptomatic VTE at 30 days in more than 2500 older medical inpatients randomized to enoxaparin or placebo, albeit the trial was underpowered due to premature termination. 38 In addition, thromboprophylaxis does not reduce mortality in medical inpatients, 5 but may be associated with a small increase in bleeding risk based on results of a meta-analysis, 4 although we did not find such an association in data from our cohort. 39 …”

Section: Discussionmentioning

confidence: 51%

Risk Assessment Models for Venous Thromboembolism in Medical Inpatients

Häfliger,

Kopp,

Darbellay Farhoumand

et al. 2024

JAMA Netw Open

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ImportanceThromboprophylaxis is recommended for medical inpatients at risk of venous thromboembolism (VTE). Risk assessment models (RAMs) have been developed to stratify VTE risk, but a prospective head-to-head comparison of validated RAMs is lacking.ObjectivesTo prospectively validate an easy-to-use RAM, the simplified Geneva score, and compare its prognostic performance with previously validated RAMs.Design, Setting, and ParticipantsThis prospective cohort study was conducted from June 18, 2020, to January 4, 2022, with a 90-day follow-up. A total of 4205 consecutive adults admitted to the general internal medicine departments of 3 Swiss university hospitals for hospitalization for more than 24 hours due to acute illness were screened for eligibility; 1352 without therapeutic anticoagulation were included.ExposuresAt admission, items of 4 RAMs (ie, the simplified and original Geneva score, the Padua score, and the IMPROVE [International Medical Prevention Registry on Venous Thromboembolism] score) were collected. Patients were stratified into high and low VTE risk groups according to each RAM.Main Outcomes and MeasuresSymptomatic VTE within 90 days.ResultsOf 1352 medical inpatients (median age, 67 years [IQR, 54-77 years]; 762 men [55.4%]), 28 (2.1%) experienced VTE. Based on the simplified Geneva score, 854 patients (63.2%) were classified as high risk, with a 90-day VTE risk of 2.6% (n = 22; 95% CI, 1.7%-3.9%), and 498 patients (36.8%) were classified as low risk, with a 90-day VTE risk of 1.2% (n = 6; 95% CI, 0.6%-2.6%). Sensitivity of the simplified Geneva score was 78.6% (95% CI, 60.5%-89.8%) and specificity was 37.2% (95% CI, 34.6%-39.8%); the positive likelihood ratio of the simplified Geneva score was 1.25 (95% CI, 1.03-1.52) and the negative likelihood ratio was 0.58 (95% CI, 0.28-1.18). In head-to-head comparisons, sensitivity was highest for the original Geneva score (82.1%; 95% CI, 64.4%-92.1%), while specificity was highest for the IMPROVE score (70.4%; 95% CI, 67.9%-72.8%). After adjusting the VTE risk for thromboprophylaxis use and site, there was no significant difference between the high-risk and low-risk groups based on the simplified Geneva score (subhazard ratio, 2.04 [95% CI, 0.83-5.05]; P = .12) and other RAMs. Discriminative performance was poor for all RAMs, with an area under the receiver operating characteristic curve ranging from 53.8% (95% CI, 51.1%-56.5%) for the original Geneva score to 58.1% (95% CI, 55.4%-60.7%) for the simplified Geneva score.Conclusions and RelevanceThis head-to-head comparison of validated RAMs found suboptimal accuracy and prognostic performance of the simplified Geneva score and other RAMs to predict hospital-acquired VTE in medical inpatients. Clinical usefulness of existing RAMs is questionable, highlighting the need for more accurate VTE prediction strategies.

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