scholarly journals The Application of Current Proposed Venous Thromboembolism Risk Assessment Model for Ambulatory Patients With Cancer

2017 ◽  
Vol 24 (3) ◽  
pp. 429-433 ◽  
Author(s):  
Hikmat Abdel-Razeq ◽  
Asem Mansour ◽  
Salwa S. Saadeh ◽  
Mahmoud Abu-Nasser ◽  
Mohammad Makoseh ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Stage Iv ◽  
Assessment Model ◽  
Risk Scores ◽  
Patients With Cancer ◽  
Risk Assessment Models ◽  
Ambulatory Patients ◽  
Treatment Paradigm ◽  
Outpatient Settings

Venous thromboembolism (VTE) is a commonly encountered problem in patients with cancer. In recent years, cancer treatment paradigm has shifted with most therapy offered in ambulatory outpatient settings. Excess of half VTEs in patients with cancer occur in outpatient settings without prior hospitalization, where current practice guidelines do not recommend routine prophylaxis. Risk assessment models (RAMs) for VTE in such patients were recently introduced. This study aims to assess the practical application of one of these models in clinical practice. Medical records and hospital electronic database were searched for patients with cancer having VTE. Known risk factors were collected, and risk assessment was done using the Khorana RAM. Over a 10-year period, 346 patients developed VTE in ambulatory settings. Median age was 57 and 59.0% were females. Lower extremities were involved in 196 (56.6%), while 96 (27.7%) had pulmonary embolism. Most (76.6%) patients had stage IV disease, only 9.0% had stage I or II disease. Only 156 (45.1%) patients were on active chemotherapy, for whom Khorana risk assessment score was calculated. In these patients, high risk was identified in 31 (19.9%) patients, while 81 (51.9%) had intermediate risk and 44 (28.2%) had low risk. No patients were on prophylaxis prior to VTE. Most ambulatory patients with cancer who developed VTE were not on chemotherapy, and many of those who were on active treatment had low Khorana risk scores. This illustrates the need to modify the model or develop a new one that takes into consideration this group of patients.

Overview of risk assessment models for venous thromboembolism in ambulatory patients with cancer

2020 ◽  
Vol 191 ◽  
pp. S50-S57
Author(s):  
Grigoris T. Gerotziafas ◽  
Isabelle Mahé ◽  
Eleftheria Lefkou ◽  
Essam AboElnazar ◽  
Hiqmat Abdel-Razeq ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Patients With Cancer ◽  
Risk Assessment Models ◽  
Ambulatory Patients

Development of a Novel Preoperative Venous Thromboembolism Risk Assessment Model

2020 ◽  
Vol 86 (9) ◽  
pp. 1098-1105
Author(s):  
Eli Mlaver ◽  
Grant C. Lynde ◽  
Claire Gallion ◽  
John F. Sweeney ◽  
Jyotirmay Sharma
Keyword(s):  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Data Entry ◽  
Predictive Ability ◽  
Clinical Decision ◽  
Assessment Model ◽  
Data Set ◽  
Improvement Project ◽  
Risk Assessment Models ◽  
American Society

Introduction Standardization of preoperative venous thromboembolism (VTE) risk assessment remains challenging due to variation in risk assessment models (RAMs) and the cumbersome workflow addition that most RAMs represent. We aimed to develop a parsimonious RAM that is automatable and actionable within the preoperative workflow. Methods We performed a case-controlled review of all 18 VTE cases reported over a 12-month period and 171 matched controls included in an institutional National Surgical Quality Improvement Project (NSQIP) data set. We examined the predictive value of the Caprini, Padua, and NSQIP RAMs. We identified the 5 most impactful risk factors in VTE development by contribution to the known RAMs. We compared the predictive ability of cancer, age, body mass index, black race, and American Society of Anesthesiologists Physical Status (ASA-PS) score, to the Caprini, Padua, and NSQIP RAMs for VTE outcomes. Finally, we evaluated concordance between each of the models. Results The Caprini Score was found to be 88.9% sensitive and 32.7% specific using a threshold of 5. The Padua score was found to be 61.1% sensitive and 47.4% specific using a threshold of 4. The novel 5-factor RAM was found to be 94.4% sensitive and 38.0% specific using a threshold of 4. The Caprini and Padua models were discordant in 26% of patients. Discussion Cumbersome manual data entry contributes to the ongoing challenge of standardized VTE risk assessment and prophylaxis. Universally documented information and patient demographics can be utilized to create clinical decision support tools that can improve the efficiency of perioperative workflow and improve the quality of care.

Risk Assessment Models for Thrombosis and Anticoagulant-Related Bleeding in Ambulatory Cancer Patients

2021 ◽  
Author(s):  
Noori A.M. Guman ◽  
Matteo Candeloro ◽  
Noémie Kraaijpoel ◽  
Marcello Di Nisio
Keyword(s):  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Arterial Thrombosis ◽  
Risk Scores ◽  
Bleeding Complications ◽  
Individual Risk ◽  
Risk Assessment Models ◽  
Increased Risk ◽  
Cancer Associated Thrombosis

AbstractCancer patients have a high risk of developing venous thromboembolism and arterial thrombosis, along with an increased risk of anticoagulant-related bleeding with primary and secondary prophylaxis of cancer-associated thrombosis. Decisions on initiation, dosing, and duration of anticoagulant therapy for prevention and treatment of cancer-associated thrombosis are challenging, as clinicians have to balance patients' individual risk of (recurrent) thrombosis against the risk of bleeding complications. For this purpose, several dedicated risk assessment models for venous thromboembolism in cancer patients have been suggested. However, most of these scores perform poorly and have received limited to no validation. For bleeding and arterial thrombosis, no risk scores have been developed specifically for cancer patients, and treatment decisions remain based on clinical gestalt and rough and unstructured estimation of the risks. The aims of this review are to summarize the characteristics and performance of risk assessment scores for (recurrent) venous thromboembolism and discuss available data on risk assessment for bleeding and arterial thrombosis in the cancer population. This summary can help clinicians in daily practice to make a balanced decision when considering the use of risk assessment models for cancer-associated venous thromboembolism. Future research attempts should aim at improving risk assessment for arterial thrombosis and anticoagulant-related bleeding in cancer patients.

scholarly journals Assessing the risk of venous thromboembolism (VTE) in ambulatory patients with cancer: Rationale and implementation of a pharmacist-led VTE risk assessment program in an ambulatory cancer centre

2021 ◽  
pp. 107815522110047
Author(s):  
Ryan Pelletier
Keyword(s):  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Risk Prediction ◽  
Risk Score ◽  
Prediction Models ◽  
Risk Prediction Models ◽  
Patients With Cancer ◽  
Assessment Program ◽  
Ambulatory Oncology ◽  
Ambulatory Patients

Objectives The objectives of this paper were to identify and compare clinical prediction models used to assess the risk of venous thromboembolism (VTE) in ambulatory patients with cancer, as well as review the rationale and implementation of a pharmacist-led VTE screening program using the Khorana Risk Score model in an ambulatory oncology centre in Sault Ste. Marie, Ontario, Canada. Data Sources PubMed was used to identify clinical practice guidelines and review articles discussing risk prediction models used to assess VTE risk in ambulatory patients with cancer. Data Summary Three commonly used VTE risk prediction models in ambulatory patients with cancer: the Khorana Risk Score, Vienna Cancer and Thrombosis Study (CATS) and Protecht Score, were identified via literature review. After considering guideline recommendations, site-specific factors (i.e. laboratory costs, time pharmacists spent calculating VTE risk) and evidence from the CASSINI and AVERT trials, a novel pharmacist-led VTE risk assessment program using the Khorana Risk Score was developed during a fourth-year PharmD clinical rotation at the Algoma District Cancer Program (ADCP) [ambulatory cancer care centre]. ADCP patients with a Khorana Risk Score of [Formula: see text] were referred to the hematologist for a full VTE workup. Considering limitations, inclusion and exclusion criteria of the CASSINI and AVERT trials, the hematologist and pharmacy team decided on appropriate initiation of thromboprophylaxis with a direct oral anticoagulant (DOAC). Conclusions The Khorana Risk Score was the chosen model used for the pharmacist-led VTE risk assessment program due to its user-friendly scoring algorithm, evidence from validation studies and clinical trials, as well as ease of integration into pharmacy workflow. More research is needed to determine if pharmacist-led VTE risk assessment programs will impact patient outcomes, such as morbidity and mortality, secondary to cancer-associated thrombosis.

scholarly journals Identification of Two Immune Related Genes Correlated With Aberrant Methylations as Prognosis Signatures for Renal Clear Cell Carcinoma

2021 ◽  
Vol 12 ◽  
Author(s):  
Zhi-Yong Yao ◽  
Chaoqung Xing ◽  
Yuan-Wu Liu ◽  
Xiao-Liang Xing
Keyword(s):  
Risk Assessment ◽  
Cox Regression ◽  
Clear Cell ◽  
Renal Clear Cell Carcinoma ◽  
Assessment Model ◽  
Risk Scores ◽  
Aberrant Methylation ◽  
Cox Regression Analysis ◽  
Risk Assessment Models ◽  
Immune Related Genes

Almost 75% of renal cancers are renal clear cell carcinomas (KIRC). Accumulative evidence indicates that epigenetic dysregulations are closely related to the development of KIRC. Cancer immunotherapy is an effective treatment for cancers. The aim of this study was to identify immune-related differentially expressed genes (IR-DEGs) associated with aberrant methylations and construct a risk assessment model using these IR-DEGs to predict the prognosis of KIRC. Two IR-DEGs (SLC11A1 and TNFSF14) were identified by differential expression, correlation analysis, and Cox regression analysis, and risk assessment models were established. The area under the receiver operating characteristic (ROC) curve (AUC) was 0.6907. In addition, we found that risk scores were significantly associated with 31 immune cells and factors. Our present study not only shows that two IR-DEGs can be used as prognosis signatures for KIRC, but also provides a strategy for the screening of suitable prognosis signatures associated with aberrant methylation in other cancers.

scholarly journals Do we need prophylactic anticoagulation in ambulatory patients with lung cancer? A review

2020 ◽  
Vol 25 (3) ◽  
pp. 255-262 ◽  
Author(s):  
Evangelos Dimakakos ◽  
Elias Kotteas ◽  
Georgia Gomatou ◽  
Theodora Katsarou ◽  
Vassilis Vlahakos ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Unmet Need ◽  
Assessment Tools ◽  
Assessment Model ◽  
Ambulatory Patients ◽  
Prophylactic Anticoagulation

Venous thromboembolism is a common complication of malignancy. Lung cancer is considered one of the most thrombogenic cancer types. Primary thromboprophylaxis is not currently recommended for all ambulatory patients with active cancer. In the present narrative review we aim to summarize recent data on the safety and efficacy of primary thromboprophylaxis as well as on venous thromboembolism risk assessment, focusing on ambulatory patients with lung cancer. A potential benefit from prophylactic anticoagulation with low molecular weight heparins in terms of venous thromboembolism risk reduction and increased overall survival in patients with lung cancer, without a significant increase in bleeding risk, has been reported in several studies. Recent studies also reveal promising results of direct oral anticoagulants regarding their efficacy as primary thromboprophylaxis in patients with cancer, including those with lung cancer. However, the use of different study methodologies and the heterogeneity of study populations among the trials limit the extraction of definite results. More randomized, controlled trials, restricted to a well-characterized population of patients with lung cancer, are greatly anticipated. The use of risk assessment tools for stratification of venous thromboembolic risk is warranted. The development of an accurate and practical risk assessment model for patients with lung cancer represents an unmet need.

scholarly journals Clinical comparison of different cardiovascular risk scores for cardiovascular risk prediction in Indian patients

2019 ◽  
Vol 7 (7) ◽  
pp. 2770
Author(s):  
Azad Abdul Salam ◽  
T. Govindan Unni ◽  
Bino Benjamin ◽  
Prasanna C. K. ◽  
Manoj Ravi
Keyword(s):  
Risk Assessment ◽  
Cardiovascular Risk ◽  
Heart Association ◽  
Assessment Model ◽  
Risk Scores ◽  
Behavioral Risk ◽  
Cvd Risk ◽  
Risk Assessment Models ◽  
Indian Patients ◽  
Number Of Patients

Background: Cardiovascular diseases (CVD) are the main cause of mortality and disability in India. Early and sustained exposure to behavioral risk factors leads to development of CVD. The present study was conducted to compare different cardiovascular calculators for CVD risk assessment models in young Indian patients presenting with myocardial infarction.Methods: This study included 85 patients with myocardial infarction (MI). Their predicted 10-year risk of CVD was calculated using three clinically most relevant risk assessment models viz. Framingham Risk score (RiskFRS), American College of Cardiology/American Heart Association (RiskACC/AHA) and the 3rd Joint British Societies risk calculator (RiskJBS).Results: RiskFRS recognized the highest number of patients (15.4%) at high CVD risk while RiskACC/AHA and RiskJBS calculators provided inferior risk assessment but statistically significant relationship. RiskFRS and RiskACC/AHA (Pearson's r 0.870, p<0.001).Conclusions: RiskFRS seems to be as most useful CVD risk assessment model in young Indian patients. RiskFRS is likely to identify the number of patients at ‘high-risk’ as compared to RiskJBS and RiskACC/AHA.

Risk assessment model for venous thromboembolism in hospitalized surgical and non-surgical patients in the 4th Hungarian Antithrombotic Guidelines entitled “Diminution and Treatment of Venous Thromboembolism”

2010 ◽  
Vol 151 (34) ◽  
pp. 1365-1374 ◽  
Author(s):  
Marianna Dávid ◽  
Hajna Losonczy ◽  
Miklós Udvardy ◽  
Zoltán Boda ◽  
György Blaskó ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Assessment Model ◽  
Surgical Patients ◽  
Risk Assessment Model

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.

Layers of Bias: A Unified Approach for Understanding Problems With Risk Assessment

2018 ◽  
Vol 46 (2) ◽  
pp. 185-209 ◽  
Author(s):  
Laurel Eckhouse ◽  
Kristian Lum ◽  
Cynthia Conti-Cook ◽  
Julie Ciccolini
Keyword(s):  
Risk Assessment ◽  
Criminal Justice ◽  
Justice System ◽  
Quantitative Risk Assessment ◽  
Risk Scores ◽  
Risk Models ◽  
Risk Assessment Models ◽  
Final Layer ◽  
The Supreme Court ◽  
Using Data

Scholars in several fields, including quantitative methodologists, legal scholars, and theoretically oriented criminologists, have launched robust debates about the fairness of quantitative risk assessment. As the Supreme Court considers addressing constitutional questions on the issue, we propose a framework for understanding the relationships among these debates: layers of bias. In the top layer, we identify challenges to fairness within the risk-assessment models themselves. We explain types of statistical fairness and the tradeoffs between them. The second layer covers biases embedded in data. Using data from a racially biased criminal justice system can lead to unmeasurable biases in both risk scores and outcome measures. The final layer engages conceptual problems with risk models: Is it fair to make criminal justice decisions about individuals based on groups? We show that each layer depends on the layers below it: Without assurances about the foundational layers, the fairness of the top layers is irrelevant.

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