Prevention of VTE in Nonsurgical Patients

Falck‐Ytter, Yngve; Francis, Charles W.; Johanson, Norman A.; Curley, Catherine; Dahl, Ola E.; Schulman, Sam; Ortel, Thomas L.; Pauker, Stephen G.; Colwell, Clifford W.

doi:10.1378/chest.11-2296

Cited by 1,770 publications

(549 citation statements)

References 173 publications

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“…In this study, more than half (61.7%) of the VTE events occurred in the patients hospitalized on the medical service, which is in keeping with the previous literature 27,28) . Recently published ACCP guidelines for administering VTE prophylaxis among hospitalized medical patients adopted the Padua Prediction Score to assess the baseline risk in this group of patients with a low or high risk of VTE 26) ; hence, we additionally compared the Caprini RAM with this scoring system among a subgroup of patients. Although the risk for VTE associated with the high/highest risk classification determined according to both RAMs was similar, the Caprini model exhibited greater sensitivity in identifying high-risk individuals among the hospitalized medical patients evaluated in this study (82.3% of the VTE patients were classified as having a high/ highest risk according to the Caprini RAM versus 30.1% according to the Padua Prediction Score).…”

Section: Discussionmentioning

confidence: 99%

“…Each patient recruited was retrospectively assessed for the risk of VTE using this model. Since the ACCP guidelines 26) also adopted another RAM, the Padua Prediction Score, to estimate the baseline risk of VTE in hospitalized medical patients, we additionally compared the Caprini model with the Padua Prediction Score in this subgroup of patients. In the Padua Prediction Score assessment, have been proposed and evaluated clinically [8][9][10][11][12][13] .…”

Section: Risk Assessment Model (Ram)mentioning

confidence: 99%

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Validation of a Venous Thromboembolism Risk Assessment Model in Hospitalized Chinese Patients: A Case-Control Study

Zhou

Wang

et al. 2014

JAT

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Aim: The appropriate selection of hospitalized patients for venous thromboembolism (VTE) prophylaxis is an important unresolved issue. We sought to validate the Caprini model, a famous individual VTE risk assessment model (RAM), in hospitalized Chinese patients. Methods: We performed a retrospective case-control study among unselected hospitalized patients admitted to a comprehensive hospital in China. A total of 347 patients were confirmed to have VTE during hospitalization, and 651 controls were randomly selected to match the patients according to medical service. Both the patients and controls were retrospectively assessed for the risk of VTE using the Caprini RAM. Results: The average Caprini cumulative risk score in the patients was significantly higher than that observed in the controls (4.69±2.58 vs 3.16±1.82, p＜0.0001). Compared with that observed in the low-risk group, a classification of high-risk according to the Caprini model was associated with a 1.65-fold increased risk of VTE (95%CI 1.05-2.61), while that of highest-risk was associated with a 4.84-fold increased risk of VTE (95%CI 3.06-7.64). After further stratifying the highest risk level with a cumulative risk score of ≥ 5 into scores of 5-6, 7-8 and ≥ 9, the patients with a score of 5-6 were found to exhibit a 3.33-fold increased risk of VTE (95%CI 2.06-5.40), those with a score 7-8 exhibited a 9.41-fold increased risk of VTE (95%CI 4.90-18.08) and those with a score of ≥ 9 exhibited a 24.69-fold (95%CI 7.98-76.40) increased risk of VTE compared with their low-risk counterparts. Conclusions: Our study suggests that the Caprini RAM can be used to effectively stratify hospitalized Chinese patients into VTE risk categories based on individual risk factors. The classification of the highest risk level with a cumulative risk score of ≥ 5 provided significantly more clinical information, and further stratification of this group of patients is needed. J Atheroscler Thromb, 2014; 21:261-272.

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Section: Discussionmentioning

confidence: 99%

Section: Risk Assessment Model (Ram)mentioning

confidence: 99%

Validation of a Venous Thromboembolism Risk Assessment Model in Hospitalized Chinese Patients: A Case-Control Study

Zhou

Wang

et al. 2014

JAT

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“…If signs of DVT were diagnosed we followed the guidelines for management of patients with suspected DVT (ref. 5,6 ). All patients admitted to our ICU from November 2013 to November 2014 were enrolled after fulfilling the inclusion criteria and in the absence of any exclusion criteria (Table 1).…”

Section: Methodsmentioning

confidence: 99%

Central venous catheter-related thrombosis in intensive care patients - incidence and risk factors: A prospective observational study

Hrdý¹,

Straževská²,

Suk³

et al. 2017

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Background. One of the complications associated with central venous catheter (CVC) placement is catheter related deep vein thrombosis (CR-DVT). However a literature search revealed little evidence of this recognised complication. The primary aim of this study was to establish the incidence rate and risk factors for the development of CR-DVT in our critically ill adult patients. Methods. All critically ill adult patients admitted to the medical-surgical ICU with CVC inserted were included in this observational prospective study. After catheter removal we performed duplex ultrasound examination to assess the patency of the vein and establish if CR-DVT was present. Results. A total number of 308 catheters met the inclusion criteria of which 198 were included in the statistical analysis. The CVC was inserted into a subclavian vein (SCV) in 139 (70%) cases and in an internal jugular vein (IJV) in 59 (30%) cases. The 28-day mortality rate was 14.1%. We found CR-DVT during duplex ultrasound examination in 47 (26%) of all cases. 33 (70%) of the CR-DVT were diagnosed in the IJV and 14 (30%) in the SCV. The risk factors for the development of CR-DVT we identified included cannulation of the IJV and the use of treatment dose of LMWH. The effect of CR-DVT on 28-day mortality was not statistically significant. Conclusion. The risk factors for CR-DVT we identified were IJV as a site for CVC cannulation and the use of therapeutic anticoagulation prior to cannulation. Our recommendation would be preferential cannulation of a subclavian vein as opposed to an internal jugular vein in order to reduce the risk of CR-DVT.

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“…The baseline period was defined as the 12‐month continuous health plan enrollment period prior to the index date and the observation period was defined as the period from the index date until whichever event of the following occurred first: end of 12 months of follow‐up, end of continuous health plan enrollment, end of data availability, end of continuous treatment (applied for the continued cohort only), or re‐initiation of oral anticoagulants (applied for the discontinued cohort only). Variables measured during the baseline period include demographics, year of index date, type of index VTE (DVT, PE, or both), VTE identified in the hospital or outpatient/ER, time from first VTE to first rivaroxaban dispensing, Quan‐Charlson comorbidity index (CCI), RIETE bleeding score,20 baseline healthcare resource utilization and costs, risk factors for VTE (including risk factors from the ACCP Evidence‐Based Clinical Practice Guidelines list)21 and bleeding 15…”

Section: Methodsmentioning

confidence: 99%

Clinical outcomes of prolonged anticoagulation with rivaroxaban after unprovoked venous thromboembolism

Berger

Seheult

Laliberté

et al. 2018

Research and Practice in Thrombosis and Haemostasis

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Essentials Clinical trials demonstrated the gain of extended anticoagulation among patients with VTE.In a real‐world setting, we evaluated outcomes of extended rivaroxaban use for unprovoked VTE.Extended rivaroxaban treatment lowered the risk of recurrent VTE among unprovoked VTE patients.Extended rivaroxaban treatment was not associated with increased risk of major bleeding. BackgroundRandomized trial data demonstrate the gain of extended duration anticoagulation in patients with venous thromboembolic events (VTE); however, real‐world data are limited.ObjectivesAssess the risk of recurrent VTE and major bleeding in a real‐world setting of patients who experienced unprovoked VTE and received extended treatment with rivaroxaban.Methods US claims databases (February 2011–April 2015) were used in this retrospective study. The study population included adult patients initiated on rivaroxaban within 7 days after their first unprovoked VTE (ie, deep vein thrombosis, pulmonary embolism) and received ≥3 months continuous rivaroxaban treatment (index date: end of 3‐month treatment). Patients who were treated beyond 3 months formed the continued cohort and the remainder formed the discontinued cohort (ie, discontinued at 3 months). Adjusted Kaplan‐Meier rates for recurrent VTE and major bleeding events were compared between cohorts with confounders being controlled through a propensity score weighting approach.ResultsPatients in the continued cohort (N = 3763) had significantly lower rates of recurrent VTE than those who discontinued (N = 1051): 0.57% vs 1.19% (P = .042), 1.07% vs 2.10% (P = .017), and 1.45% vs 2.60% (P = .023) at 3, 6, and 12 months, respectively. No significant differences in the rate of major bleeding were observed between cohorts. A sensitivity analysis among unprovoked VTE patients receiving rivaroxaban for ≥6 months showed similar results.ConclusionsContinued rivaroxaban treatment beyond an initial 3‐ or 6‐month treatment period significantly lowered the risk of recurrent VTE without a significant increase of major bleeding, compared to treatment discontinued at 3 or 6 months.

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Prevention of VTE in Nonsurgical Patients

Cited by 1,770 publications

References 173 publications

Validation of a Venous Thromboembolism Risk Assessment Model in Hospitalized Chinese Patients: A Case-Control Study

Validation of a Venous Thromboembolism Risk Assessment Model in Hospitalized Chinese Patients: A Case-Control Study

Central venous catheter-related thrombosis in intensive care patients - incidence and risk factors: A prospective observational study

Clinical outcomes of prolonged anticoagulation with rivaroxaban after unprovoked venous thromboembolism

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