Risk assessment models for thromboprophylaxis of medical patients

Samama, M; Combe, S.; Conard, J.; Horellou, Marie‐Hélène

doi:10.1016/j.thromres.2011.09.025

Cited by 21 publications

(14 citation statements)

References 30 publications

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“…140–146 Although risk-assessment models have been derived for prediction of VTE in hospitalized, nonsurgical patients, these models are highly variable in terms of the number and type of predictors, and the strengths of associations with VTE, and lack generalizability and adequate validation. 147,148 …”

Section: Risk Factors For Incident Vtementioning

confidence: 99%

Epidemiology of venous thromboembolism

2015

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Thrombosis can affect any venous circulation. Venous thromboembolism (VTE) includes deep-vein thrombosis of the leg or pelvis, and its complication, pulmonary embolism. VTE is a fairly common disease, particularly in older age, and is associated with reduced survival, substantial health-care costs, and a high rate of recurrence. VTE is a complex (multifactorial) disease, involving interactions between acquired or inherited predispositions to thrombosis and various risk factors. Major risk factors for incident VTE include hospitalization for surgery or acute illness, active cancer, neurological disease with leg paresis, nursing-home confinement, trauma or fracture, superficial vein thrombosis, and—in women—pregnancy and puerperium, oral contraception, and hormone therapy. Although independent risk factors for incident VTE and predictors of VTE recurrence have been identified, and effective primary and secondary prophylaxis is available, the occurrence of VTE seems to be fairly constant, or even increasing.

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Section: Risk Factors For Incident Vtementioning

confidence: 99%

Epidemiology of venous thromboembolism

2015

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“…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] . Generally, these models can be classified as involving two types of strategies: group risk assessment and individual risk assessment.…”

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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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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“…28,30 Clinicians often simply bypass the clinical decision support offered in the tool, rather than checking off all risk factors, adding up the point total, and identifying the appropriate prophylaxis choices based on the point total. 28 Other point-based RAM (reviewed elsewhere [34][35][36] ) pose similar implementation challenges.…”

Section: Approach 3: Buckets Of Riskmentioning

confidence: 99%

Venous thromboembolism prevention guidelines for medical inpatients: Mind the (implementation) Gap

Maynard

Jenkins

Merli

2013

Journal of Hospital Medicine

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BACKGROUND Hospital‐associated nonsurgical venous thromboembolism (VTE) is an important problem addressed by new guidelines from the American College of Physicians (ACP) and American College of Chest Physicians (AT9). METHODS Narrative review and critique. RESULTS Both guidelines discount asymptomatic VTE outcomes and caution against overprophylaxis, but have different methodologies and estimates of risk/benefit. Guideline complexity and lack of consensus on VTE risk assessment contribute to an implementation gap. Methods to estimate prophylaxis benefit have significant limitations because major trials included mostly screening‐detected events. AT9 relies on a single Italian cohort study to conclude that those with a Padua score ≥4 have a very high VTE risk, whereas patients with a score <4 (60% of patients) have a very small risk. However, the cohort population has less comorbidity than US inpatients, and over 1% of patients with a score of 3 suffered pulmonary emboli. The ACP guideline does not endorse any risk‐assessment model. AT9 includes the Padua model and Caprini point‐based system for nonsurgical inpatients and surgical inpatients, respectively, but there is no evidence they are more effective than simpler risk‐assessment models. CONCLUSIONS New VTE prevention guidelines provide varied guidance on important issues including risk assessment. If Padua is used, a threshold of 3, as well as 4, should be considered. Simpler VTE risk‐assessment models may be superior to complicated point‐based models in environments without sophisticated clinical decision support. Journal of Hospital Medicine 2013;8:582–588. © 2013 Society of Hospital Medicine

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Risk assessment models for thromboprophylaxis of medical patients

Cited by 21 publications

References 30 publications

Epidemiology of venous thromboembolism

Epidemiology of venous thromboembolism

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

Venous thromboembolism prevention guidelines for medical inpatients: Mind the (implementation) Gap

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