Validation of risk assessment models for venous thrombosis in hospitalized medical patients

Cobben, Michelle R. R.; Nemeth, Banne; Lijfering, Willem M.; Cannegieter, Suzanne C.

doi:10.1002/rth2.12181

Cited by 17 publications

(27 citation statements)

References 31 publications

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“…In contrast, however, for thromboprophylaxis this does not necessarily seem to be the case. Despite individualized antithrombotic treatment often being used in medical patients, 17…”

Section: How To Further Reduce V Te R Ate S Following Tha and Tk A?mentioning

confidence: 99%

“…Orthopedic surgeons individualize the type and size of the implant to match patient specific needs and anatomical characteristics, known as “individualized therapy or personalized medicine.” In contrast, however, for thromboprophylaxis this does not necessarily seem to be the case. Despite individualized antithrombotic treatment often being used in medical patients, 17 in the majority of elective orthopedic surgeries thromboprophylaxis is administered according to hospital protocol; a similar thromboprophylactic regimen for all patients undergoing THA or TKA is advised (ie, a population‐based approach). For instance, patients with a history of VTE, patients without any comorbidities, and patients who are discharged within 2 days are all considered to be equal in terms of VTE risk and hence receive the same dosage and duration of thromboprophylaxis.…”

Section: How To Further Reduce Vte Rates Following Tha and Tka?mentioning

confidence: 99%

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Preventing VTE following total hip and knee arthroplasty: Is prediction the future?

Nemeth

Nelissen

Arya

et al. 2021

Journal of Thrombosis and Haemostasis

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Venous thromboembolism (VTE) is a common complication following total hip arthroplasty (THA) and total knee arthroplasty (TKA). Many guidelines advise on the ideal pharmacological thromboprophylaxis strategy; however, despite its use, approximately 1.5% of patients still develop symptomatic VTE. Considering the large number of THAs and TKAs performed worldwide (2.5 million in total), the impact of VTE following these interventions is enormous. This paper discusses a concept how to further lower rates of VTE and bleeding complications following surgery. By stratifying patients according to their risk, we can optimize the balance between VTE and bleeding for each individual. This way, low‐risk patients may be safely withheld from treatment (and avoid unnecessary bleeding complications and costs), whereas high‐risk patients should receive adequate therapy (for instance, an increased thromboprophylaxis dosage and duration). An individualized strategy requires a well‐functioning VTE prediction model following THA and TKA to help physicians to decide on optimal thromboprophylaxis therapy.

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“…In contrast, however, for thromboprophylaxis this does not necessarily seem to be the case. Despite individualized antithrombotic treatment often being used in medical patients, 17…”

Section: How To Further Reduce V Te R Ate S Following Tha and Tk A?mentioning

confidence: 99%

Section: How To Further Reduce Vte Rates Following Tha and Tka?mentioning

confidence: 99%

Preventing VTE following total hip and knee arthroplasty: Is prediction the future?

Nemeth

Nelissen

Arya

et al. 2021

Journal of Thrombosis and Haemostasis

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“…The risk of VTE increases significantly during hospitalization, although not enough to Primary prevention of venous thromboembolism in pregnancy 16,18,19 Clinical 40 were best able to identify low-risk patients (negative predictive value, > 99%). 38 American Society of Hematology guidelines recommend IMPROVE VTE or the Padua Prediction Score for risk stratification. 41 While the Caprini score only designates 11% of eventual VTE cases as low risk, both the IMPROVE VTE and Padua scores miss more than 35% of eventual VTE.…”

Section: Primary Vte Prevention In Med-surg Hospitalizationsmentioning

confidence: 99%

“…41 While the Caprini score only designates 11% of eventual VTE cases as low risk, both the IMPROVE VTE and Padua scores miss more than 35% of eventual VTE. 38 Because LMWH prophylaxis has been shown to reduce VTE by 40% without increasing the risk of major bleeding, using Caprini should prevent 2 VTEs for every 1000 patients, without an increase in major bleeding and with 13 additional minor bleeding events. 42 ❚ Critically ill patients are assumed to be at high risk of VTE and do not require stratification.…”

Section: Primary Vte Prevention In Med-surg Hospitalizationsmentioning

confidence: 99%

Primary prevention of VTE spans a spectrum

Arnold¹

2020

The Journal of Family Practice

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High mortality from VTE makes primary prevention appealing. Guidelines and assessment tools offer a variety of patient-specific strategies and agents. V enous thromboembolism (VTE) is a common and dangerous disease, affecting 0.1%-0.2% of the population annually-a rate that might be underreported. 1 VTE is a collective term for venous blood clots, including (1) deep vein thrombosis (DVT) of peripheral veins and (2) pulmonary embolism, which occurs after a clot travels through the heart and becomes lodged in the pulmonary vasculature. Twothirds of VTE cases present clinically as DVT 2 ; most mortality from VTE disease is caused by the 20% of cases of pulmonary embolism that present as sudden death. 1 VTE is comparable to myocardial infarction (MI) in incidence and severity. In 2008, 208 of every 100,000 people had an MI, with a 30-day mortality of 16/100,000 3 ; VTE disease has an annual incidence of 161 of every 100,000 people and a 28-day mortality of 18/100,000. 4 Although the incidence and severity of MI are steadily decreasing, the rate of VTE appears constant. 3,5 The high mortality of VTE suggests that primary prevention, which we discuss in this article, is valuable (see "Key points: Primary prevention of venous thromboembolism, " page 388). Risk factors Virchow's triad of venous stasis, vascular injury, and hypercoagulability describes predisposing factors for VTE. 6 Although venous valves promote blood flow, they produce isolated low-flow areas adjacent to valves that become concentrated and locally hypoxic, increasing the risk of clotting. 7 The great majority of DVTs (≥ 96%) occur in the lower extremity, 8 starting in the calf; there, 75% of cases resolve spontaneously before they extend into the deep veins of the proximal leg. 7 One-half of DVTs that do move into the proximal leg eventually embolize. 7 Major risk factors for VTE comprise inherited conditions, medical history, medical therapeutics, and behaviors (TABLE 1). 9-11 Unlike the preventive management of coronary artery disease (CAD), there is no simple, generalized prevention

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“…Several RAM (scores) have been developedand appear to share similar discriminative performances, albeit with clinically relevant differences in calibrations . Previously, we simplified the original Geneva RAM to improve its applicability, as well as its incorporation into electronic medical charts.…”

Section: Introductionmentioning

confidence: 99%

External validation of the simplified Geneva risk assessment model for hospital‐associated venous thromboembolism in the Padua cohort

Blondon¹,

Righini²,

Nendaz

et al. 2020

Journal of Thrombosis and Haemostasis

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Background The simplified Geneva risk assessment model (RAM) predicts the risk of hospitalization‐related venous thromboembolism (VTE) in medical inpatients in its developmental cohort but has not been validated. Objectives To externally validate the simplified Geneva RAM. Patients/Methods For this secondary analysis of a prospective cohort set in Padua, we calculated the simplified Geneva RAM for all participants. They were followed up for 90 days for the occurrence of adjudicated VTE. Thirty‐ and 90‐day risks of VTE were estimated by the Kaplan‐Meier method, and categories of risks compared with a Cox regression model adjusted for the use of thromboprophylaxis. Results Among 1180 medical inpatients, the 90‐day risk of symptomatic VTE was 3.1%. The simplified Geneva RAM classified 56.9% as high risk (≥3 points; 90‐day risk of VTE of 5.2%) and 43.1% as low risk (<3 points; 90‐day risk of VTE of 0.4%). Compared with low‐risk participants, high‐risk participants had an 18‐fold greater risk of VTE than low‐risk participants (hazard ratio [HR] 17.9, 95% confidence interval [CI] 4.3‐74.7). A very high‐risk category (≥7 points) identified 5.3% of participants with a 9.5% probability of VTE at 90 days. Conclusions In this external validation study, we confirm the excellent discrimination and clinically adequate calibration of the simplified Geneva RAM as a stratification tool to guide the use of thromboprophylaxis.

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Validation of risk assessment models for venous thrombosis in hospitalized medical patients

Cited by 17 publications

References 31 publications

Preventing VTE following total hip and knee arthroplasty: Is prediction the future?

Preventing VTE following total hip and knee arthroplasty: Is prediction the future?

Primary prevention of VTE spans a spectrum

External validation of the simplified Geneva risk assessment model for hospital‐associated venous thromboembolism in the Padua cohort

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