Validation of risk assessment models predicting venous thromboembolism in inpatients with AECOPD: a multicenter cohort study

2021 ◽  
Author(s):  
Chen Zhou ◽  
Qun Yi ◽  
Huiqing Ge ◽  
Hailong Wei ◽  
Huiguo Liu ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Venous Thromboembolism ◽  
High Risk ◽  
Assessment Model ◽  
Risk Level ◽  
Chronic Obstructive ◽  
Multicenter Cohort Study ◽  
Mortality And Morbidity ◽  
Increased Risk ◽  
Study Population

Background: As inpatients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) are at increased risk for venous thromboembolism (VTE), identifying high-risk patients requiring thromboprophylaxis is critical to reduce the mortality and morbidity associated with VTE. This study aimed to evaluate and compare the validities of the Padua Prediction Score and Caprini risk assessment model (RAM) in predicting the risk of VTE in inpatients with AECOPD. Methods: The inpatients with AECOPD were prospectively enrolled from seven medical centers of China between September 2017 and January 2020. Caprini and Padua scores were calculated on admission, and the incidence of 3-month VTE was investigated. Results: Among the 3277 eligible patients with AECOPD, 128 patients (3.9%) developed VTE within 3 months after admission. The distribution of the study population by the Caprini risk level was as follows: high, 53.6%; moderate, 43.0%; and low, 3.5%. The incidence of VTE increased by risk level as high, 6.1%; moderate, 1.5%; and low, 0%. According to the Padua RAM, only 10.9% of the study population was classified as high risk and 89.1% as low risk, with the corresponding incidence of VTE 7.9% and 3.4%, respectively. The Caprini RAM had higher area under curve (AUC) compared with the Padua RAM (0.713  0.021 vs 0.644 ± 0.023, P = 0.029). Conclusion: The Caprini RAM was superior to the Padua RAM in predicting the risk of VTE in inpatients with AECOPD and might better guide thromboprophylaxis in these patients.

External validation of the VTE-BLEED score for predicting major bleeding in stable anticoagulated patients with venous thromboembolism

2017 ◽  
Vol 117 (06) ◽  
pp. 1164-1170 ◽  
Author(s):  
Frederikus A. Klok ◽  
Stefano Barco ◽  
Stavros V. Konstantinides
Keyword(s):  
Venous Thromboembolism ◽  
High Risk ◽  
Major Bleeding ◽  
External Validation ◽  
Chronic Phase ◽  
Bleeding Risk ◽  
Bleeding Events ◽  
Risk Of Bleeding ◽  
Increased Risk ◽  
Study Population

SummaryOne of the main determinants of establishing the optimal treatment duration of patients with venous thromboembolism (VTE) is the risk of major bleeding during long-term anticoagulant therapy. The 6-variable VTE-BLEED score was recently developed to enable estimation of this bleeding risk. This study aimed at externally validating VTE-BLEED. This was a post-hoc study of the randomised, double-blind, double-dummy, Hokusai-VTE study that compared edoxaban versus warfarin for treatment of VTE. VTE-BLEED was calculated in all 8,240 study patients. The numbers of adjudicated major bleeding events during ‘stable anticoagulation’, i. e. occurring after day 30, in patients with low (total score <2 points) and high risk of bleeding (total score ≥2 points) were compared for the overall study population, patients randomised to edoxaban or warfarin, and for important patient subcategories. During ‘stable’ anticoagulation, major bleeding occurred in 1.02% (40/3,903) and 0.82% (32/3,899) of patients treated with warfarin and edoxaban, respectively. For the overall study population, the risks of bleeding in the low and high risk groups were 0.51% and 2.03%, respectively, for an odds ratio (OR) of 4.04 (95% confidence interval [CI]: 2.51–6.48). ORs were 5.04 (95%CI: 2.62–9.69) and 3.09 (95%CI: 1.54–6.22) for warfarin and edoxaban, respectively. VTE-BLEED was consistently able to identify patients at a 2.5- to 11-fold higher bleeding risk across all the predefined subcategories, as well as for the treatment period between day 30 to day 180, and beyond day 180. In conclusion, patients identified as high risk by VTE-BLEED had a four-fold increased risk of bleeding during the chronic phase of treatment.Supplementary Material to this article is available online at www.thrombosis-online.com.

scholarly journals Performance of Khorana Risk Score for Prediction of Venous Thromboembolism in Patients With Hepatocellular Carcinoma

2017 ◽  
Vol 24 (3) ◽  
pp. 471-476 ◽  
Author(s):  
Y. Wang ◽  
B. M. Attar ◽  
H. E. Fuentes ◽  
J. Yu ◽  
Huiyuan Zhang ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Risk Score ◽  
Univariate Analysis ◽  
International Classification Of Diseases ◽  
Assessment Model ◽  
Radiographic Examination ◽  
Risk Assessment Model ◽  
Mortality And Morbidity

Cancer-associated venous thromboembolism (VTE) is one of the leading causes of mortality and morbidity among patients with malignancy. The Khorana risk score (KRS) is currently the best validated risk assessment model to stratify risks of VTE development in ambulatory patients with cancer. In the current study, we assessed the performance of KRS in patients with hepatocellular carcinoma (HCC). We retrospectively analyzed patients with diagnosis of HCC (screened by International Classification of Diseases [ ICD-9] and ICD-10 code, confirmed with radiographic examination and/or histopathology) at a large public hospital over 15 years (January 2000 through July 2015). Cases with VTE were identified through radiographic examination and blindly adjudicated. Khorana risk score was calculated for each patient, and its association with VTE development and mortality was assessed. Among 270 patients with HCC, 16 (5.9%) cases of VTE were identified, including 7 (43.8%) pulmonary embolism, 4 (25%) peripheral deep vein thrombosis, and 6 (37.5%) intra-abdominal thrombosis. One hundred eighty-four (68.1%) patients had a KRS of 0 and 86 (31.9%) patients had a KRS >0. Most of the thrombotic (n = 9, 56%) events occurred in the low-risk group. In univariate analysis, only prechemotherapy leukocyte count equal to or greater than 11 000/μL was statistically significant in the prediction of VTE incidence. After adjusting for confounding factors in multivariate analysis, KRS >0 was not predictive of VTE (hazard ratio [HR] = 1.83, 95% confidence interval [CI] = 0.81-4.15, P = .15) or mortality (HR = 1.61, 95% CI = 0.92-2.81, P = .09). Khorana risk score did not predict VTE development or mortality in patients with HCC. Design of HCC-specific risk assessment model for VTE development is necessary.

scholarly journals Evaluating post-operative venous thromboembolism risk in urology patients using a validated risk assessment model

2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Winston Paul René Padayachee ◽  
Mohamed Haffejee ◽  
Marietha Nel
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Venous Thromboembolism ◽  
High Risk ◽  
Significant Risk ◽  
Assessment Model ◽  
Risk Category ◽  
Risk Assessment Model ◽  
Surgical Morbidity ◽  
Significant Difference

Abstract Background Venous thromboembolism (VTE) is an important cause of post-surgical morbidity and mortality. This study aimed to apply a validated risk assessment model to evaluate the risk of post-operative VTE in urology patients. Methods This prospective descriptive observational study used the Caprini risk assessment model to evaluate VTE risk in patients planned for elective urology surgery at a tertiary Johannesburg hospital from January to June 2020. Results Two hundred and twenty-six patients with a mean age of 52 years were evaluated for post-operative VTE risk. The population was generally overweight, with a mean BMI of 26.3 kg/m2. The mean Caprini score was 4.42, reflecting a population at high risk for post-operative VTE. There was no statistically significant difference between males and females in this regard. On average, participants had three risk factors for post-operative VTE. Fifteen per cent of all patients were at low risk for VTE, while 40.3% of participants were categorised as moderate risk. The category with the highest percentage of participants (44.7%) was the high-risk category (Caprini score ≥ 5). High-risk patients undergoing oncology surgery comprised 16.8% of the population, and these patients may require extended duration pharmacological thromboprophylaxis to prevent VTE. The most clinically significant risk factors for post-operative VTE included age, obesity, malignancy and HIV infection. Conclusion Venous thromboembolism may be difficult to diagnose, and clinicians may underestimate the risk for it to develop. Risk assessment models, such as the Caprini score, are objective and a practical tool to guide the application of thromboprophylaxis. The application of the Caprini RAM in the elective urological surgery population at Chris Hani Baragwanath Academic Hospital yields similar results to studies performed elsewhere on similar surgical populations. Further research is required to evaluate whether the actual incidence of VTE correlates with the risk assessment in this population. Clinician compliance with the use of RAMs as well as the corresponding recommendations for prophylaxis may need to be evaluated. A validated risk assessment model which accounts for procedure-specific risks in urology may be useful.

Venous thromboembolism in cancer patients – Risk scores and recent randomised controlled trials

2012 ◽  
Vol 108 (12) ◽  
pp. 1042-1048 ◽  
Author(s):  
Cihan Ay ◽  
Ingrid Pabinger ◽  
Johannes Thaler
Keyword(s):  
Risk Assessment ◽  
Venous Thromboembolism ◽  
High Risk ◽  
Cancer Patients ◽  
Randomised Controlled Trials ◽  
Incidence Rates ◽  
Risk Scores ◽  
Controlled Trials ◽  
Increased Risk ◽  
Randomised Controlled

SummaryCancer patients are at increased risk of developing venous thromboembolism (VTE). Guidelines recommend routine thromboprophylaxis in hospitalised acutely ill cancer patients and in myeloma patients receiving combination treatments including thalidomide or lenalidomide. Currently, thromboprophylaxis is not recommended in cancer out-patients. It is the aim of this review to give an overview of studies that applied scores for the risk assessment of cancer-related VTE. We will also discuss randomised controlled trials (RCTs) that investigated primary thromboprophylaxis in cancer patients. Recently, Khorana et al. published a practical and reproducible risk assessment score that includes clinical and laboratory parameters for the stratification of cancer patients according to their propensity to develop VTE. Patients assigned to the high-risk group are likely to benefit most from primary thromboprophylaxis. This score was validated in prospective and retrospective observational studies. In the Vienna Cancer and Thrombosis Study (CATS) the score was expanded by adding two biomarkers, and the prediction of VTE was considerably improved. In recent RCTs including cancer patients with different malignancies it was shown that thromboprophylaxis is safe and effective. However, VTE incidence rates were low. To date, no data is available from interventional studies applying thromboprophylaxis in cancer patients categorised into high-risk groups on the basis of risk assessment with scores. From the available literature we conclude that risk assessment for VTE is feasible in cancer patients;however, interventional studies to investigate the safety and efficacy of thromboprophylaxis in a high risk cancer population have yet to be performed.

scholarly journals Venous Thromboembolism Prophylaxis in Medical Intensive Care Unit: An Audit

2021 ◽  
Author(s):  
Basant Kumar Pathak ◽  
P Harikrishnan ◽  
Manish Manrai
Keyword(s):  
Risk Assessment ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Venous Thromboembolism ◽  
High Risk ◽  
Medical Records ◽  
Assessment Model ◽  
P Value ◽  
Vte Prophylaxis ◽  
Significant Difference

Introduction: Venous Thromboembolism (VTE) is a major cause of morbidity and mortality in patients admitted to healthcare facilities. This can be prevented by giving thromboprophylaxis to patients after assessing the risk for VTE. This however is not being routinely done leading to underuse of thromboprophylaxis due to inadequate practice of risk assessment. Aim: To conduct an audit of VTE prophylaxis in Intensive Care Unit (ICU) based on Padua score and International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) Risk Assessment Model (VTE RAM). Materials and Methods: This was a cross-sectional observational study and the data was collected from medical records of patients retrospectively who were admitted to medical ICU between October 2019 and December 2019. Based on medical records risk assessment was done using the Padua score and IMPROVE VTE RAM. The prophylaxis given to patients was scrutinised for appropriateness based on American Society of Haematology (ASH) guidelines. The two validated scores Padua score and IMPROVE VTE RAM were compared with each other for any significant difference in the risk assessment made using Chi-square test and p-value <0.05 were considered significant. Results: Out of the 176 patients risk assessment was not done in any patient. On calculating the Padua score, 149 patients (84.66%) were in high risk for VTE (Padua Score ≥4) and amongst them only 76 (51%) patients received thromboprophylaxis. On calculating the IMPROVE VTE RAM score, 137 patients (77.84%) were in moderate or high risk for VTE requiring prophylaxis and amongst them only 76 (55.47%) patients received thromboprophylaxis. The accuracy of clinician’s judgement without risk assessment was 58.52% (95% CI: 65.80%-51.24%) and 64.20% (95% CI: 71.28%-57.12%) as compared to risk assessment by Padua score and IMPROVE VTE RAM, respectively. There was no significant difference between IMPROVE VTE RAM and Padua score with respect to risk assessment for VTE (p-value of 0.10). Conclusion: The practice of VTE prophylaxis is grossly inadequate and there is a requirement to sensitise the healthcare providers about the importance of risk assessment for VTE.

scholarly journals Risk assessment of venous thromboembolism and bleeding in COVID-19 patients

2020 ◽  
Author(s):  
Jin-fu Xu ◽  
Lan Wang ◽  
Lan Zhao ◽  
Feng Li ◽  
Ji Liu ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Venous Thromboembolism ◽  
High Risk ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Bleeding Risk ◽  
Assessment Model ◽  
Prediction Score ◽  
Hypoxemic Respiratory Failure ◽  
Major Hemorrhage

Abstract Background The coronavirus disease 2019 (COVID-19) is a newly recognized illness that has spread rapidly all over the world. Severe hypoxemic respiratory failure from COVID-19 will bring high risk of venous thromboembolism (VTE). Our study aims to identify in-hospital VTE risk and bleeding risk in COVID-19 patients. Methods We retrospectively studied 138 consecutively enrolled patients with COVID-19 and identified in-hospital VTE and bleeding risk by Padua Prediction Score and Improve bleed risk assessment model. The clinical data and features were analyzed in VTE patients. Results Our findings identified that 23 (16.67%) patients with COVID-19 were at high risk for VTE according to Padua prediction score, and 9(6.52%) patients were at high risk of bleeding for VTE prophylaxis according to Improve prediction score. Fifteen critically ill patients faced double high risk from thrombosis (Padua score more than 4 points in all 15[100%] patients) and hemorrhage (Improve score more than 7 points in 9[60.0%] patients). Thrombotic events were identified in four patients (2.9%) of all COVID-19 patients. All of them were diagnosed as deep vein thrombosis by ultrasound after 3 to 18 days after admission. Three (75.0%) were critically ill patients, which means the incidence of VTE among critically ill patients was 20%. One major hemorrhage was happened in critically ill patients during VTE treatment. Conclusion Critically ill patients with COVID-19 suffered both high risk of thrombosis and bleeding risks. More effective VTE prevention strategies based on an individual assessment of bleeding risks were necessary for critically ill patients with COVID-19.

Risk assessment models for venous thromboembolism in acutely ill medical patients

2017 ◽  
Vol 117 (04) ◽  
pp. 801-808 ◽  
Author(s):  
Anna Stuck ◽  
David Spirk ◽  
Jil Schaudt ◽  
Nils Kucher
Keyword(s):  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Risk Score ◽  
Logistic Model ◽  
Assessment Model ◽  
Prediction Score ◽  
Published Data ◽  
Medical Patients ◽  
Multivariable Model ◽  
Increased Risk

SummaryAlthough the use of thromboprophylaxis is recommended for acutely ill medical patients at increased risk of venous thromboembolism (VTE), it remains unclear which risk assessment model (RAM) should be routinely used to identify at-risk patients requiring thromboprophylaxis. We therefore aimed to describe existing RAMs, and to compare these tools in terms of validity and applicability for clinical decisionmaking. We performed a comprehensive systematic search in MEDLINE from the date of initiation until May 2016 for studies in acutely ill medical patients investigating validity of RAMs for VTE. Two reviewers independently screened the title, abstract, and full text, and evaluated the characteristics of studies, and the composition, evidence of validation, and results on validity of the RAMs. We included 11 studies assessing eight RAMs: 4-Element RAM, Caprini RAM, a full logistic model, Geneva risk score, IMPROVE-RAM, Kucher Model, a “Multivariable Model”, and Padua Prediction Score. The 4-Element RAM, IMPROVE-RAM, Multivariable Model, and full logistic model had derivation by identifying factors with predictive power. The other four RAMs were empirically generated based on consensus guidelines, published data, and clinical expertise. The Kucher Model, the Padua Prediction Score, the Geneva Risk Score and the IMPROVE-RAM underwent multicenter external validation. The Kucher Model, the Padua Prediction Score, and the Geneva Risk Score improved rates of thromboprophylaxis or clinical outcomes. In conclusion, existing RAMs to evaluate the need of thromboprophylaxis in acutely ill medical patients are difficult to compare and none fulfills the criteria of an ideal RAM. Nevertheless, the adequacy of thromboprophylaxis may be improved by implementing one of the validated RAMs.

Risk Assessment Model Based on SVDD and Fuzzy Regression Method

2011 ◽  
Vol 58-60 ◽  
pp. 1807-1812
Author(s):  
Hui Li Zhou ◽  
Wen Bing Chang ◽  
Sheng Han Zhou
Keyword(s):  
Risk Assessment ◽  
High Risk ◽  
Assessment Model ◽  
Fuzzy Regression ◽  
Risk Level ◽  
Support Vector ◽  
Support Vector Data Description ◽  
Risk Assessment Model ◽  
Evaluation Indexes ◽  
Model Based

The paper aims to solve the problem of insufficient high risk data in risk assessment of R&D projects. A one-class classification method called support vector data description (SVDD) is studied, and an intelligent risk assessment model based on SVDD with fuzzy regression information is also proposed. The model comes into being a new approach. Applying this approach, firstly verify the conversional risk evaluation indexes by fuzzy regression technique to develop a sensitive index system. Secondly the study uses the historical risk data referring to these indexes to train the SVDD one-class classifier. Unlike previously proposed intelligent methods of risk assessment, with this model the risk level can be distinguished only by training of low risk data. The results of its application on an example show that the method is feasible for risk assessment with the fuzzy high risk data.

scholarly journals Risk Factors for Venous Thromboembolism in Hospitalized Patients in the Chinese Population

2018 ◽  
Vol 13 (1) ◽  
pp. 82-89 ◽  
Author(s):  
Chunling Wang ◽  
Fuping Cui ◽  
Junqiu Li ◽  
Xiangzhi Yuan ◽  
Jia Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Venous Thromboembolism ◽  
High Risk ◽  
Chinese Population ◽  
Blood Clot ◽  
Hospitalized Patients ◽  
Assessment Model ◽  
Risk Assessment Model ◽  
Medical Patients

AbstractVenous thromboembolism (VTE) refers to the formation of a blood clot inside veins and has a high risk of inducing medical accidents. An effective risk assessment model will help screen high risk populations and prevent the occurrence of VTE. In this study, 287 VTE cases were collected and analyzed for risk factors in a Chinese population. The risks of VTE were evaluated using the Caprini and Padua models. Our results indicated that the Caprini model was more effective in evaluating VTE risk among hospitalized patients than the Padua model. As well, the Caprini model was more relevant in VTE risk assessment among surgery patients compared with internal medicine patients, while the Padua model showed no significant differences. In our studies, the most frequent risk factors included obesity, medical patients currently at bed rest, and severe lung disease. Our studies provide clinical support on selecting the suitable risk assessment model of VTE in the Chinese population.

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