Derivation and Validation of a Risk Factor Model to Identify Medical Inpatients at Risk for Venous Thromboembolism

Author(s):  
Michael B Rothberg ◽  
Aaron Hamilton ◽  
M. Todd Greene ◽  
Jacqueline Fox ◽  
Oleg Lisheba ◽  
...  

Background: Venous thromboembolism (VTE) prophylaxis is recommended for hospitalized medical patients at high risk for VTE. Multiple risk assessment models exist, but few have been compared in large data sets. Methods: We constructed a derivation cohort using 6 years of data from 13 hospitals to identify risk factors associated with developing VTE within 14 days of admission. VTE was identified using a complex algorithm combining administrative codes and clinical data. We developed a multivariable prediction model and applied it to 2 validation cohorts: a temporal cohort, including two additional years and a cross-validation, in which we refit the model excluding one hospital at a time, and applied the refitted model to the holdout hospital. Performance was evaluated using the C-statistic. Results: The derivation cohort included 160,928 patients with a 14-day VTE rate of 0.79%. The final multivariable model contained 13 patient risk factors. The model had an optimism corrected C-statistic of 0.80 and good calibration. The temporal validation cohort included 55,301 patients, with a VTE rate of 0.74%. Based on the c-statistic, the Cleveland Clinic Model (CCM) outperformed the Padua model (0.76 vs. 0.72, p<0.01). The CCM was more sensitive (65.8% vs. 60.4%, p=0.05) and more specific (74.9% vs. 71.4%, p<.001), with higher positive (1.9% vs. 1.5%, p<.001) and negative predictive values (99.7% vs. 99.6%, p=0.01). C-statistics for the CCM at individual hospitals ranged from 0.64 to 0.76. Conclusion: A new VTE risk assessment model outperformed the Padua model. After further validation it could be recommended for widespread use.

2019 ◽  
Vol 9 (3) ◽  
pp. 36 ◽  
Author(s):  
Bui My Hanh ◽  
Le Quang Cuong ◽  
Nguyen Truong Son ◽  
Duong Tuan Duc ◽  
Tran Tien Hung ◽  
...  

Venous thromboembolism (VTE) is a frequent preventable complication among surgical patients. Precise risk assessment is a necessary step for providing appropriate thromboprophylaxis and reducing mortality as well as morbidity caused by VTE. We carried out this work to define the rate of VTE postoperatively, following a Caprini score, and to determine VTE risk factors through a modified Caprini risk scoring system. This multicenter, observational, cohort study involved 2,790,027 patients who underwent surgery in four Vietnamese hospitals from 01/2017 to 12/2018. All patients who were evaluated before surgery by using a Caprini risk assessment model (RAM) and monitored within 90 days after surgery. The endpoint of the study was ultrasound-confirmed VTE. Our data showed that the 90-day postoperative VTE was found in 3068 patients. Most of VTE (46.97%) cases were found in the highest risk group (Caprini score > 5). A total of 37.19% were observed in the high risk group, while the rest (15.84%) were from low to moderate risk groups. The likelihood of occurring VTE was heightened 2.83 times for patients with a Caprini score of 3–4, 4.83 times for a Caprini score of 5–6, 8.84 times for a score of 7–8, and 11.42 times for a score of >8, comparing to ones with a score of 0 to 2 (all p values < 0.05). Thus, the frequency of postoperative VTE rises substantially, according to the advanced Caprini score. Further categorizing patients among the highest risk group need delivering more appropriate thromboprophylaxis.


Author(s):  
Jean Baptiste Ramampisendrahova ◽  
Andriamanantsialonina Andrianony ◽  
Aina Andrianina Vatosoa Rakotonarivo ◽  
Mamisoa Bodohasina Rasamoelina ◽  
Eric Andriantsoa ◽  
...  

The purpose of this research is to ascertain the prevalence of postoperative venous thromboembolism in the Department of Surgery at Anosiala University Hospital and to identify risk factors for developing postoperative venous thromboembolism using the Caprini Risk Assessment Model. From December 2017 to October 2019, this was a 22-month prospective cohort research conducted at Anosiala University Hospital. It included all adult patients over the age of 18 who were operated on in an emergency or on a planned basis by the Department of Surgery. This research included 662 participants. Within 30 days after surgery, the risk of venous thromboembolism was 0.3 percent. According to the overall Caprini score, 25.2 percent of patients were classified as having a low risk of venous thromboembolism, 25.2 percent as having a moderate risk, 29.5 percent as having a high risk, and 20.1 percent as having the greatest risk. Patients in the highest risk category (scoring 5) had a substantially increased chance of having venous thromboembolism after surgery (p = 0.0007). Only major open surgery was related with a statistically significant increase in postoperative venous thromboembolism (p = 0.028). Age 75 years, elective arthroplasty, and hip, pelvic, or leg fractures were not linked with postoperative venous thromboembolism statistically significantly (p> 0.05). Our findings indicate that the Caprini risk assessment model might be used successfully to avoid postoperative venous thromboembolism in surgical patients in Madagascar, since patients in the highest risk category had a considerably increased chance of developing postoperative venous thromboembolism.


2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Winston Paul René Padayachee ◽  
Mohamed Haffejee ◽  
Marietha Nel

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.


Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 3568-3568
Author(s):  
Jifang Zhou ◽  
Gregory Sampang Calip ◽  
Edith A. Nutescu

Abstract Background: Venous thromboembolism (VTE) is associated with significant morbidity, functional disability and mortality which leads to annual direct medical costs of 6 to 8 billion U.S. dollars. The incidence of VTE among patients with sickle cell disease (SCD) is significantly higher than in those without SCD, with lifetime risk of up to 25%. The highly variable clinical phenotypes of SCD, in addition to complex pathogenesis of thrombosis in SCD, are challenges to the early identification of high-risk patients and timely initiation of anticoagulant prophylaxis. Objective: To develop a population-based risk assessment model (Predictive AlgoRithm of VTE in SCD, PARViS) for the identification of SCD patients at high-risk of VTE using least absolute shrinkage and selection operator (LASSO) methodology and compare its validity to the Caprini VTE risk assessment model. Method: We conducted a retrospective cohort study using the 2009-2014 Truven Health MarketScan® databases to identify commercially-insured health plan enrollees with VTE and SCD based on International Classification of Diseases (ICD) codes for inpatient and outpatient encounters. Baseline characteristics were assessed over the 6 months period following cohort entry and a risk window for any VTE events starting from day 181 after cohort entry and onwards. The clinical outcomes were defined as occurrence of VTE over the 30-, 90- and 180-day period. The population-based cohort was divided into derivation and validation sets in a 2:1 ratio. The risk score was calculated using LASSO generalized linear regression models and divided into three risk categories for predicting 180-day VTE risk. Kaplan-Meier survivor functions were estimated for VTE rates by estimated risk score and censored for end of continuous enrollment, and end of observation period. The C-statistic was used to assess the prediction performance of the 7-factor risk score, which was compared with the Caprini VTE risk prediction model. Results: Among 11,774 subjects with SCD in the derivation cohort, the mean (SD) age at enrollment was 32.1 (19.8) years and 62.2% were female. From the validation cohort, 5949 SCD subjects were analyzed, participants' mean (SD) age at enrollment was 32.2 (19.7) years, and 62.6% were female. The 30-, 90- and 180-day VTE rates of the overall cohort were 0.6%, 1.3% and 2.0%, respectively. The risk model included age, recent central vein catheter use (<30 day), active cancer, history of VTE, iron overload, osteomyelitis and pulmonary hypertension. Patients with SCD in the validation cohort were stratified into high-, intermediate- and low-risk in 2:3:5 ratio by VTE risk scores. Demographics and distribution of VTE risk factors are listed in Table 1. The rates of VTE at 180-days were 0.47% (95%CI 0.35%-0.64%), 1.38% (95%CI 1.10%-1.73%),6.71% (95%CI 5.94%-7.57%). [Figure 1] In the derivation cohort, C statistics were 0.845 (95%CI 0.818-0.872) for 7-factor RAM in predicting 180-day VTE, 0.883 (95%CI 0.853-0.914) for 90-day VTE, and 0.917 (95%CI 0.875-0.959) for 30-day VTE. In the validation cohort, C statistics were 0.833 (95%CI 0.791-0.875) for 7-factor VTE risk assessment model in predicting 180-day VTE, 0.877 (95%CI 0.831-0.923) for 90-day VTE, and 0.942 (95%CI 0.911-0.972) for 30-day VTE. Using the Caprini VTE risk prediction model, we found statistically significant differences (p<0.0001) with C-statistics for 180-, 90- and 30-day VTE prediction of 0.721 (95%CI 0.672-0.770), 0.775 (95%CI 0.719-0.830), and 0.826 (95%CI 0.759-0.892). [Figure 2] Conclusion: We developed and validated a 7-factor VTE risk assessment model specific to patients with SCD (PARViS). With its straightforward calculation and demonstrated accurate prediction of 6-month VTE rates in patients with SCD, the PARViS model can prove to be a useful prediction tool for clinical practitioners. Disclosures No relevant conflicts of interest to declare.


Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 173-173
Author(s):  
Neil Zakai ◽  
Peter Callas ◽  
Allen Repp ◽  
Mary Cushman

Abstract Abstract 173FN2 Introduction: Multiple government organizations (i.e. the Joint Commission in the United States and the National Institute for Health and Clinical Excellence in the United Kingdom) mandate venous thrombosis (VT) risk assessment for hospitalized patients and provision of VT prophylaxis, however there are no validated VT risk assessment models (RAM) available for use in medical inpatients. Methods: Between January 2002 and June 2009 all cases of VT complicating medical admissions were identified using ICD-9 codes and confirmed by medical record review at a 500 bed teaching hospital. Two controls without VT were frequency matched to each case by admission service (medicine, cardiology, and oncology) and admission year. VT required positive imaging or autopsy. Medical history, presenting conditions, and use of VT prophylaxis in cases and controls were assessed by chart review. Weighted logistic regression was used to calculate odds ratios (OR) and the Taylor series method for 95% confidence intervals (CI) accounting for VT prophylaxis use (both mechanical and pharmacologic). A RAM was developed using clinical judgment and sequentially adding risk factors into a multivariable model. A point value was assigned for each risk factor by dividing the b coefficients' by the lowest b coefficient value and rounding to the nearest integer. To validate the model, the 95% CI for the C-statistic was calculated using bootstrapping with 1000 replicate samples. Results: 299 cases of VT and 601 matched controls were reviewed. The rate of VT per 1000 admissions (95% CI) was 4.6 (3.9, 5.4). Table 1 presents the RAM with the point value for each risk factor. The c-statistic for the model was 0.73 (95% CI 0.70, 0.76). Using a cut-off of ≥2 points as high risk, 79% of cases and 39% of controls were classified as high risk. The probability of VT in the absence of VT prophylaxis for a score <2 was 1.5 (95% CI 1.0, 2.3) per 1000 admissions and for a score ≥2 was 8.8 (95% CI 4.1, 18.8) per 1000 admissions. To evaluate a score assessed by clinical characteristics only, we assessed a score with the same risk factors but removing platelet count and white cell count from the model. The C-statistic was 0.71 (95% CI 0.68, 0.74) and 74% of cases and 39% of controls were high risk. Stratification by admission service or admission to an intensive care unit did not affect interpretation of the results. Conclusion: We present an internally validated RAM that assesses the risk of VT complicating medical admission. The score is simple, relies only on information easily known at the time of admission, and could be incorporated into an electronic medical record. It will allow clinicians to assess VT risk at admission for medical inpatients and weigh the risks and benefits of pharmacologic VT prophylaxis. The RAM will enable further studies to determine optimal VT prevention strategies in medical inpatients. Disclosures: No relevant conflicts of interest to declare.


2018 ◽  
Vol 13 (1) ◽  
pp. 82-89 ◽  
Author(s):  
Chunling Wang ◽  
Fuping Cui ◽  
Junqiu Li ◽  
Xiangzhi Yuan ◽  
Jia Wang ◽  
...  

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.


2010 ◽  
Vol 151 (34) ◽  
pp. 1365-1374 ◽  
Author(s):  
Marianna Dávid ◽  
Hajna Losonczy ◽  
Miklós Udvardy ◽  
Zoltán Boda ◽  
György Blaskó ◽  
...  

A kórházban kezelt sebészeti és belgyógyászati betegekben jelentős a vénásthromboembolia-rizikó. Profilaxis nélkül, a műtét típusától függően, a sebészeti beavatkozások kapcsán a betegek 15–60%-ában alakul ki mélyvénás trombózis vagy tüdőembólia, és az utóbbi ma is vezető kórházi halálok. Bár a vénás thromboemboliát leggyakrabban a közelmúltban végzett műtéttel vagy traumával hozzák kapcsolatba, a szimptómás thromboemboliás események 50–70%-a és a fatális tüdőembóliák 70–80%-a nem a sebészeti betegekben alakul ki. Nemzetközi és hazai felmérések alapján a nagy kockázattal rendelkező sebészeti betegek többsége megkapja a szükséges trombózisprofilaxist. Azonban profilaxis nélkül marad a rizikóval rendelkező belgyógyászati betegek jelentős része, a konszenzuson alapuló nemzetközi és hazai irányelvi ajánlások ellenére. A belgyógyászati betegek körében növelni kell a profilaxisban részesülők arányát és el kell érni, hogy trombózisrizikó esetén a betegek megkapják a hatásos megelőzést. A beteg trombóziskockázatának felmérése fontos eszköze a vénás thromboembolia által veszélyeztetett betegek felderítésének, megkönnyíti a döntést a profilaxis elrendeléséről és javítja az irányelvi ajánlások betartását. A trombózisveszély megállapításakor, ha nem ellenjavallt, profilaxist kell alkalmazni. „A thromboemboliák kockázatának csökkentése és kezelése” című, 4. magyar antithromboticus irányelv felhívja a figyelmet a vénástrombózis-rizikó felmérésének szükségességére, és elsőként tartalmazza a kórházban fekvő belgyógyászati és sebészeti betegek kockázati kérdőívét. Ismertetjük a kockázatbecslő kérdőíveket és áttekintjük a kérdőívekben szereplő rizikófaktorokra vonatkozó bizonyítékokon alapuló adatokat.


2021 ◽  
pp. 026835552110212
Author(s):  
Cassia RL Ferreira ◽  
Marcos de Bastos ◽  
Mirella L Diniz ◽  
Renan A Mancini ◽  
Yan S Raposo ◽  
...  

Objectives To analyze the inter-observer reliability of risk for venous thromboembolism (VTE) in a population of adult acutely-ill medical patients. Methods In this prospective cohort study, we collected risk factors and risk classification for VTE using RAM IMPROVE7. Kappa statistics was used to evaluate inter-observer reliability between lead clinicians and trained researchers. We evaluated occurrence of VTE in patients with mismatched classification. Results We included 2,380 patients, median age 70 years (interquartile range [IQR], 58-79), 56.2% female. Adjusted Kappa for VTE risk factors ranged from substantial (0.64, 95% confidence interval [CI], 0.61-0.67) for “immobilization”, to almost perfect (0.98; 95% CI 0.97-0.99) for “thrombophilia”; risk classification was 0.64 (95% CI 0.60-0.67). Divergent risk classification occurred in 434 patients (18.2%) of whom seven (1.6%) developed VTE. Conclusion Despite substantial to almost perfect reliability between observers for risk factors and risk classification, lead clinicians tended to underestimate the risk for VTE.


2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1429.1-1429
Author(s):  
Q. Peng ◽  
L. Long ◽  
J. Liu

Background:Venous thromboembolism (VTE) includes thrombotic disease of venous system, but primarily includes lower extremity deep vein thrombosis (DVT) and pulmonary embolism (PE). Population-based epidemiological studies have shown an association between systemic autoimmune diseases and VTE[1]. The Padua prediction score(PPS) is a new 20-point risk assessment model proposed by Professor Barbar et al[2] in 2010. A large number of researches have shown that low serum albumin concentration is associated with an increased risk of VTE [3],but there is a lack of studies on serum albumin in VTE, and there are no reports on PPS in rheumatology inpatients.Objectives:To investigate the status of VTE in patients in the department of rheumatology, and to explore the value of PPS combined with serum albumin in the identification of VTE in this patient population.Methods:Baseline data of inpatients in rheumatology department were collected at Sichuan Provincial People’s Hospital from September 2018 to September 2020. Occurrence of VTE was compared between high and low risk groups. PPSs were analyzed in VTE and non-VTE patients. Multivariate logistic regression was used to analyze the independent risk factors of VTE. The receiver operating characteristic curve was used to evaluate the probablity of value of rheumatic inpatients with VTE assessed by PPS,serum albumin and PPS with serum albumin. P<0.05 indicates that the difference was statistically significant.Results:A total of 2282 patients were included in this study, and 50(2.2%) had symptomatic VTE. Among the symptomatic VTE cases,38(1.6%) had DVT only,8(0.4%) had PE only, and 4(0.2%) were diagnosed with DVT and PE. PPSs in VTE and non-VTE groups were 3.00(2.00~6.00) and2.00(1.00~2.00) respectively (P< 0.05). One hundred and eighty-eight cases was divided into high-risk group of VTE (PPS≥4), while 2094 cases (PPS<4) were in the low-risk group. Logistic regression analysis showed that known thrombophilic condition, history of VTE, reduced mobility, and D-dimer were independent risk factors of VTE in rheumatology patients, the odd ration(OR) values were 161.90, 26.08, 8.73,and1.04. Serum albumin was the independent protection factor [OR= 0.92(95%CI:0.87~0.98)]. The AUC of PPS model, serum albumin model and the combined predictive model were 0.77, 0.75, 0.84, respectively. The difference between the combined prediction model and PPS model was statistically significant (Z=3.813, P<0.05). The optimal sensitivity of PPS and serum albumin models is 60%, 82%, respectively, and the optimal specificity of is 82.5%,58.6%, respectively. The combination model corresponds to a sensitivity of 62% and a specificity of 90.4%.Conclusion:The incidence of symptomatic VTE was relatively higher in hospitalized patients in rheumatology department. Serum albumin was the protective factor. The combination of albumin and PPS can improve the accuracy of screening for VTE in rheumatology in-patients.References:[1]Tamaki H,Khasnis A.Venous thromboembolism in systemic autoimmune diseases: A narrative review with emphasis on primary systemic vasculitides.[J].Vasc Med, 2015, 20: 369-76.[2]Barbar S, Noventa F, Rossetto V,et al. A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: the Padua Prediction Score[J]. J Thromb Haemost,2010,8(11):2450–2457.[3]Kunutsor SK,Seidu S,Katechia DT et al. Inverse association between serum albumin and future risk of venous thromboembolism: interrelationship with high sensitivity C-reactive protein.[J].Ann Med, 2018, 50: 240-248.Disclosure of Interests:None declared


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