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 Models for predicting venous thromboembolism in ambulatory patients with lung cancer: a systematic review protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e055322
Author(s):  
Ann-Rong Yan ◽  
Indira Samarawickrema ◽  
Mark Naunton ◽  
Gregory M Peterson ◽  
Desmond Yip ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Systematic Review ◽  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Risk Prediction ◽  
Prediction Models ◽  
Data Extraction ◽  
Cochrane Library ◽  
Risk Prediction Models ◽  
Ambulatory Patients

IntroductionVenous thromboembolism (VTE) is a common complication in patients with cancer and has a determining role in the disease prognosis. The risk is significantly increased with certain types of cancer, such as lung cancer. Partly due to difficulties in managing haemorrhage in outpatient settings, anticoagulant prophylaxis is only recommended for ambulatory patients at high risk of VTE. This requires a precise VTE risk assessment in individual patients. Although VTE risk assessment models have been developed and updated in recent years, there are conflicting reports on the effectiveness of such risk prediction models in patient management. The aim of this systematic review is to gain a better understanding of the available VTE risk assessment tools for ambulatory patients with lung cancer and compare their predictive performance.Methods and analysisA systematic review will be conducted using MEDLINE, Cochrane Library, CINAHL, Scopus and Web of Science databases from inception to 30 September 2021, to identify all reports published in English describing VTE risk prediction models which have included adult ambulatory patients with primary lung cancer for model development and/or validation. Two independent reviewers will conduct article screening, study selection, data extraction and quality assessment of the primary studies. Any disagreements will be referred to a third researcher to resolve. The included studies will be assessed for risk of bias and applicability. The Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies will be used for data extraction and appraisal. Data from similar studies will be used for meta-analysis to determine the incidence of VTE and the performance of the risk models.Ethics and disseminationEthics approval is not required. We will disseminate the results in a peer-reviewed journal.PROSPERO registration numberCRD42021245907.

scholarly journals A Review on Automatic Mammographic Density and Parenchymal Segmentation

2015 ◽  
Vol 2015 ◽  
pp. 1-31 ◽  
Author(s):  
Wenda He ◽  
Arne Juette ◽  
Erika R. E. Denton ◽  
Arnau Oliver ◽  
Robert Martí ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Risk Assessment ◽  
Risk Prediction ◽  
Prediction Models ◽  
Prevention Measures ◽  
Clinical Environment ◽  
Tissue Segmentation ◽  
Risk Prediction Models ◽  
The Impact

Breast cancer is the most frequently diagnosed cancer in women. However, the exact cause(s) of breast cancer still remains unknown. Early detection, precise identification of women at risk, and application of appropriate disease prevention measures are by far the most effective way to tackle breast cancer. There are more than 70 common genetic susceptibility factors included in the current non-image-based risk prediction models (e.g., the Gail and the Tyrer-Cuzick models). Image-based risk factors, such as mammographic densities and parenchymal patterns, have been established as biomarkers but have not been fully incorporated in the risk prediction models used for risk stratification in screening and/or measuring responsiveness to preventive approaches. Within computer aided mammography, automatic mammographic tissue segmentation methods have been developed for estimation of breast tissue composition to facilitate mammographic risk assessment. This paper presents a comprehensive review of automatic mammographic tissue segmentation methodologies developed over the past two decades and the evidence for risk assessment/density classification using segmentation. The aim of this review is to analyse how engineering advances have progressed and the impact automatic mammographic tissue segmentation has in a clinical environment, as well as to understand the current research gaps with respect to the incorporation of image-based risk factors in non-image-based risk prediction models.

Epidemiology, risk and outcomes of venous thromboembolism in cancer

2012 ◽  
Vol 32 (02) ◽  
pp. 115-125 ◽  
Author(s):  
L. Russo ◽  
A. Falanga
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Brain Cancer ◽  
Prediction Models ◽  
Disease Stage ◽  
Individual Factors ◽  
Scientific Societies ◽  
Risk Prediction Models ◽  
Patients With Cancer ◽  
Increased Risk

SummaryCancer is associated with a fourfold increased risk of venous thromboembolism (VTE). The risk of VTE varies according to the type of malignancy (i. e. pancreatic cancer, brain cancer, lymphoma) and its disease stage and individual factors (i. e. sex, race, age, previous VTE history, immobilization, obesity). Preventing cancer-associated VTE is important because it represents a significant cause of morbidity and mortality. In order to identify cancer patient at particularly high risk, who need thromboprophylaxis, risk prediction models have become available and are under validation. These models include clinical risk factors, but also begin to incorporate biological markers. The major American and European scientific societies have issued their recommendations to guide the management of VTE in patients with cancer.In this review the principal aspects of epidemiology, risk factors and outcome of cancer-associated VTE are summarized.

scholarly journals Risk Prediction Models for Mortality in Ambulatory Patients With Heart Failure

2013 ◽  
Vol 6 (5) ◽  
pp. 881-889 ◽  
Author(s):  
Ana C. Alba ◽  
Thomas Agoritsas ◽  
Milosz Jankowski ◽  
Delphine Courvoisier ◽  
Stephen D. Walter ◽  
...  
Keyword(s):  
Heart Failure ◽  
Risk Prediction ◽  
Prediction Models ◽  
Risk Prediction Models ◽  
Patients With Heart Failure ◽  
Ambulatory Patients

scholarly journals The angiostatic peptide endostatin enhances mortality risk prediction in pulmonary arterial hypertension

2021 ◽  
pp. 00378-2021
Author(s):  
Catherine E. Simpson ◽  
Megan Griffiths ◽  
Jun Yang ◽  
Melanie K. Nies ◽  
R. Dhananjay Vaidya ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Risk Prediction ◽  
Mortality Risk ◽  
Prediction Models ◽  
Independent Predictor ◽  
Right Atrial ◽  
Risk Prediction Models ◽  
Pulmonary Arterial

Currently available noninvasive markers for assessing disease severity and mortality risk in pulmonary arterial hypertension (PAH) are unrelated to fundamental disease biology. Endostatin, an angiostatic peptide known to inhibit pulmonary artery endothelial cell migration, proliferation, and survival in vitro, has been linked to adverse hemodynamics and shortened survival in small PAH cohorts. This observational cohort study sought to assess 1) the prognostic performance of circulating endostatin levels in a large, multicenter PAH cohort, and 2) the added value gained by incorporating endostatin into existing PAH risk prediction models.Endostatin ELISAs were performed on enrollment samples collected from 2017 PAH subjects with detailed clinical data, including survival times. Endostatin associations with clinical variables, including survival, were examined using multivariable regression and Cox proportional hazards models. Extended survival models including endostatin were compared to null models based on the REVEAL risk prediction tool and ESC/ERS low risk criteria using likelihood ratio tests, Akaike and Bayesian information criteria, and C-statistics.Higher endostatin was associated with higher right atrial pressure, mean pulmonary arterial pressure, and pulmonary vascular resistance and with shorter six-minute walk distance (p<0.01). Mortality risk doubled for each log-higher endostatin (hazard ratio 2.3, 95% confidence interval 1.6 to 3.4, p<0.001). Endostatin remained an independent predictor of survival when incorporated into existing risk prediction models. Adding endostatin to REVEAL-based and ESC/ERS criteria-based risk assessment strategies improved mortality risk prediction.Endostatin is a robust, independent predictor of mortality in PAH. Adding endostatin to existing PAH risk prediction strategies improves PAH risk assessment.

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.

Sign in / Sign up

Export Citation Format

Share Document