VTE Risk Assessment and Prophylaxis: The Reliability of Clinical Assessment by Medical Housestaff,

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4199-4199
Author(s):  
Monica Reddy Muppidi ◽  
Ashima Sahni ◽  
Abhimanyu Saini ◽  
Samrat Khanna ◽  
Larissa Verda ◽  
...  
Keyword(s):  
Risk Assessment ◽  
High Risk ◽  
Risk Stratification ◽  
Hospitalized Patients ◽  
Risk Assessments ◽  
Rater Reliability ◽  
Vte Prophylaxis ◽  
National Quality ◽  
Medical Inpatients ◽  
Very High

Abstract Abstract 4199 BACKGROUND: Hospital acquired venous thromboembolism (VTE) is a significant cause of mortality in hospitalized patients. The incidence of VTE may be as high as 40% in medical inpatients and is preventable in 50–75%. However, only one-half of eligible hospitalized patients receive adequate thromboprophylaxis. In response, national quality organizations and expert panels recommend a VTE risk assessment and risk-based prophylaxis for every inpatient. Point scoring systems have been proposed for risk stratification but have not been prospectively validated, and may be misleading; a recent study showed that medical residents using a point system made errors in risk stratification and choice of VTE prophylaxis. Thus, the optimal method of assessing VTE risk and whether these assessments can have adequate inter-rater reliability remains unknown. OBJECTIVES: 1. To compare the inter-rater reliability of VTE risk assessment by paired expert reviewers within the paired team and to the clinical team's assessment. 2. To evaluate the appropriateness of VTE prophylaxis administered by clinical teams compared to expert reviewer's determinations. METHODS: We performed a cross-sectional study at a 464-bed public teaching hospital. Medical patients were randomly selected and their charts abstracted by four expert housestaff reviewers (two teams of two reviewers) who had been trained through literature review, case discussion and participation in guideline development. Paired reviewers independently assessed VTE risk blinded to the other reviewer's determination using clinical data and a ‘3-bucket' model (low; moderate or high; very high). Appropriateness of prophylaxis was based on VTE risk as well as contraindications to prophylaxis. Reviewers also recorded the primary teams' VTE risk assessment and prophylaxis choices. Reviewer discrepancies were adjudicated through a third blinded review. We calculated the inter-rater reliability between paired reviewers and between reviewers and clinical teams using weighted Kappa scores (K). We recorded reasons for disagreement between reviewers and teams. RESULTS: A total of 40 charts were reviewed and analyzed for agreement on VTE risk. 36 charts were analyzed for appropriateness of VTE prophylaxis; 4 patients on therapeutic anticoagulation were excluded from this analysis. Compared to expert reviewers (E), medical teams (M) significantly underestimated VTE risk, as follows: low risk (E, 2.5% vs M, 20%); moderate to high risk (E,85% vs M,75%); very high risk (E, 12.5% vs M, 5%); P=0.004. In 11 of 12 cases of disagreement, team's assessment of VTE risk was lower than that determined by reviewers. Compared to the inter-rater reliability between experts and clinical teams, reliability was significantly better for the paired experts both for VTE risk assessment (P<0.01) and choice of prophylaxis (P<0.01). Among the 8 (22%) of patients for whom the reviewers determined VTE prophylaxis was suboptimal, for most (n=6) the method of prophylaxis was less intensive than recommended by the guidelines, and the most common reason was failure to restart prophylaxis after an invasive procedure or transfer of care. CONCLUSIONS: Our study shows that expert reviewers can assess VTE risk with a high degree of reliability. The risk assessments by clinical teams during routine clinical evaluation did not correlate well with expert risk stratification and underestimated the risk of VTE in medical inpatients. Incorrect risk assessments were common but the most frequent reasons for underutilization of VTE prophylaxis were oversights in ordering prophylaxis during care transitions or after invasive procedures. Although we trained our experts to be highly reliable in risk assessment this training cannot be generalized to most provider groups. An optimal approach to improving VTE risk assessment in clinical settings involving trainees would include real time decision support for risk assessment with linked VTE prophylaxis choices appropriate to the level of risk at the point of care. Disclosures: No relevant conflicts of interest to declare.

scholarly journals "Has the Pendulum Swung Too Far? Evaluation of the Appropriate Use of VTE Prophylaxis for Medical Inpatients."

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 4745-4745
Author(s):  
Courtney A Fay ◽  
Marijeta Pekez ◽  
Anna Thomas ◽  
Bhakti Deshmukh ◽  
Naveed Jan ◽  
...  
Keyword(s):  
Risk Assessment ◽  
High Risk ◽  
Hospitalized Patients ◽  
Low Risk ◽  
Prediction Score ◽  
Admission Criteria ◽  
Vte Prophylaxis ◽  
Medical Inpatients ◽  
Current Guidelines ◽  
Anticoagulated Patients

Abstract Introduction: Venous thromboembolism (VTE) is the most common cause of hospital death. Pharmacologic intervention has become the standard of care in the prevention of VTE in hospitalized patients. However, studies have not been able to show a consistent benefit of VTE prophylaxis on mortality in hospitalized medical patients. Medical inpatients are a very heterogenous group; not all of them need VTE prophylaxis. Current guidelines recommend the use of heparin or related drugs as VTE prophylaxis in medical inpatients at increased risk of thrombosis, and recommends against pharmacologic VTE prophylaxis in patients at low risk. Several risk assessment modules including the Padua Prediction Score, attempt to identify patients at high-risk for thromboembolism. The goal of the study was to evaluate if risk is assessed and defined by clinicians prior to prescribing VTE prophylaxis. Methods A retrospective chart analysis was performed for patients admitted to the medicine service from January 2015 to June 2015. The initial arrival orders as well as the history and physical documented by the admitting physician were reviewed to determine if the risk of VTE was recorded and if VTE prophylaxis was prescribed. Patients were stratified as either admission or observation and the type of anticoagulation was recorded. If the admitting physician did not perform a VTE risk assessment, risk of VTE was calculated using the Padua Prediction Score. Results: Data was collected on a total of 648 patients. 314 (48%) patients met admission criteria and 334 (52%) patients met observation criteria. Chemical VTE prophylaxis was prescribed for 262 of the 314 (83%) admissions and 215 of the 334 (64%) observation patients. Of the 262 admissions that received chemical VTE prophylaxis, 240 (92%) of these patients were considered low-risk based on the Padua Prediction Score (Figure 1). 201 of the 215 (93%) observation patients that received chemical VTE prophylaxis were calculated to be low-risk (Figure 2). Adverse events were found to occur in 7 of the 648 (1.1%) patients that received chemical VTE prophylaxis. Conclusion: Inappropriate use of chemical VTE prophylaxis was observed in a majority of medical inpatients. Discussion: Routine use of VTE prophylaxis is not recommended. Current guidelines advise practitioners to evaluate all hospitalized patients for risk of VTE and bleeding prior to the initiation of VTE prophylaxis. Risk assessment tools such as the Padua Prediction Score help discriminate those patients at high risk of VTE and bleeding. However, this study shows that most clinicians do not perform a proper risk assessment for thromboembolism and bleeding prior to the initiation of VTE prophylaxis. Significant bleeding and thrombocytopenia were the most common complications identified in patients who received pharmacologic intervention. Although the rate of complications was low, further studies are needed to address additional negative consequences from the overuse of anticoagulation such as cost, nursing time and patient discomfort. Figure 1 VTE risk assessment of anticoagulated patients who met admission criteria Figure 1. VTE risk assessment of anticoagulated patients who met admission criteria Figure 2 VTE risk assessment of anticoagulated patients who met observation criteria Figure 2. VTE risk assessment of anticoagulated patients who met observation criteria Disclosures No relevant conflicts of interest to declare.

Preventing the Preventable—Improving thromboprophylaxis in oncology in-patients

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 19648-19648
Author(s):  
R. Stevens ◽  
R. Jones ◽  
S. Oliveras ◽  
T. Abdullah ◽  
R. Leonard
Keyword(s):  
Risk Assessment ◽  
High Risk ◽  
Initial Study ◽  
High Risk Group ◽  
Assessment Model ◽  
Risk Assessment Model ◽  
Indwelling Catheters ◽  
Vte Prophylaxis ◽  
Oncology Ward ◽  
Very High

19648 Background: Cancer and its treatments are well recognised risk factors for venous thromboembolism (VTE). The risk of VTE complications in malignancy can be increased with surgery, chemotherapy (including adjuvant chemotherapy), hormone therapy and central indwelling catheters. Low molecular weight heparin (LMWH) has been shown to safely reduce the incidence of VTE in cancer patients however it is often not a standard of care within the oncology in-patient setting. Method: A retrospective study was carried out on admissions to the oncology ward for 1 month. Individual VTE risk was assessed using the modified THRiFT II risk assessment model and it was documented whether patients received any form of prophylaxis and the incidence of VTE. Following this study a VTE prophylaxis protocol was designed and implemented on the oncology ward and a repeat prospective study was carried out. Results: The initial study showed that in the very high risk group only 15% patients received thromboprophylaxis. 4 episodes of VTE occurred during the initial study period and these all occurred in patients stratified as very high risk. On the repeat study the results showed 50% of patients assessed as very high risk were now receiving prophylaxis. There was also a reduction in the rate of inappropriate prophylaxis from 17% to 0% in those assessed as lower risk. Conclusion: Primary prevention of VTE helps to reduce the morbidity and mortality associated with this common complication of malignancy. This study shows how a simple risk assessment model coupled with raised awareness of VTE risk improved the prophylaxis of those at highest risk and also reduced inappropriate usage in those at lesser risk. No significant financial relationships to disclose.

scholarly journals An Alternative Risk Assessment Model of Urban Waterlogging: A Case Study of Ningbo City

2021 ◽  
Vol 13 (2) ◽  
pp. 826
Author(s):  
Meiling Zhou ◽  
Xiuli Feng ◽  
Kaikai Liu ◽  
Chi Zhang ◽  
Lijian Xie ◽  
...  
Keyword(s):  
Risk Assessment ◽  
High Risk ◽  
Assessment Model ◽  
Risk Assessments ◽  
Risk Assessment Model ◽  
Risk Area ◽  
The North ◽  
Coastal Cities ◽  
Risk Areas ◽  
The City

Influenced by climate change, extreme weather events occur frequently, and bring huge impacts to urban areas, including urban waterlogging. Conducting risk assessments of urban waterlogging is a critical step to diagnose problems, improve infrastructure and achieve sustainable development facing extreme weathers. This study takes Ningbo, a typical coastal city in the Yangtze River Delta, as an example to conduct a risk assessment of urban waterlogging with high-resolution remote sensing images and high-precision digital elevation models to further analyze the spatial distribution characteristics of waterlogging risk. Results indicate that waterlogging risk in the city proper of Ningbo is mainly low risk, accounting for 36.9%. The higher-risk and medium-risk areas have the same proportions, accounting for 18.7%. They are followed by the lower-risk and high-risk areas, accounting for 15.5% and 9.6%, respectively. In terms of space, waterlogging risk in the city proper of Ningbo is high in the south and low in the north. The high-risk area is mainly located to the west of Jiangdong district and the middle of Haishu district. The low-risk area is mainly distributed in the north of Jiangbei district. These results are consistent with the historical situation of waterlogging in Ningbo, which prove the effectiveness of the risk assessment model and provide an important reference for the government to prevent and mitigate waterlogging. The optimized risk assessment model is also of importance for waterlogging risk assessments in coastal cities. Based on this model, the waterlogging risk of coastal cities can be quickly assessed, combining with local characteristics, which will help improve the city’s capability of responding to waterlogging disasters and reduce socio-economic loss.

scholarly journals Risk assessment in precapillary pulmonary hypertension: a comparative analysis

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Thomas Sonnweber ◽  
Eva-Maria Schneider ◽  
Manfred Nairz ◽  
Igor Theurl ◽  
Günter Weiss ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Pulmonary Hypertension ◽  
High Risk ◽  
Risk Stratification ◽  
Risk Prediction ◽  
Mortality Risk ◽  
Assessment Tool ◽  
Risk Models ◽  
Non Invasive

Abstract Background Risk stratification is essential to assess mortality risk and guide treatment in patients with precapillary pulmonary hypertension (PH). We herein compared the accuracy of different currently used PH risk stratification tools and evaluated the significance of particular risk parameters. Methods We conducted a retrospective longitudinal observational cohort study evaluating seven different risk assessment approaches according to the current PH guidelines. A comprehensive assessment including multi-parametric risk stratification was performed at baseline and 4 yearly follow-up time-points. Multi-step Cox hazard analysis was used to analyse and refine risk prediction. Results Various available risk models effectively predicted mortality in patients with precapillary pulmonary hypertension. Right-heart catheter parameters were not essential for risk prediction. Contrary, non-invasive follow-up re-evaluations significantly improved the accuracy of risk estimations. A lack of accuracy of various risk models was found in the intermediate- and high-risk classes. For these patients, an additional evaluation step including assessment of age and right atrium area improved risk prediction significantly. Discussion Currently used abbreviated versions of the ESC/ERS risk assessment tool, as well as the REVEAL 2.0 and REVEAL Lite 2 based risk stratification, lack accuracy to predict mortality in intermediate- and high-risk precapillary pulmonary hypertension patients. An expanded non-invasive evaluation improves mortality risk prediction in these individuals.

Investigation of a 22-gene genomic classifier (GC) for risk stratification and molecular subtyping in an Asian prostate cancer (PCa) cohort.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 249-249
Author(s):  
Wei Loong Sherman Yee ◽  
Wai Yee Woo ◽  
Adelene Sim ◽  
Kar Perng Low ◽  
Alice Meng ◽  
...  
Keyword(s):  
High Risk ◽  
Risk Stratification ◽  
Racial Differences ◽  
White Men ◽  
Risk Groups ◽  
Molecular Subtyping ◽  
Basal Subtype ◽  
Grid Database ◽  
Risk Patients ◽  
Very High

249 Background: A 22-gene GC has been proposed to refine risk stratification of localized PCa by conventional NCCN criteria, and this may potentially influence treatment recommendations. Nonetheless, majority of studies looking at the utility of GC were conducted in White and non-White men from Western cohorts. We therefore investigated the association of GC with NCCN risk groups (RG) in an Asian PCa cohort. Additionally, we examined for inter-racial differences in molecular subtyping between Asian and White/non-White PCa. Methods: GC (Decipher Biosciences Inc., CA) was performed on diagnostic biopsies of men who were treated with radiotherapy +/- hormonal therapy at a single institution (N = 75). ISUP Gleason’s grade (GG) and tumor cellularity were reviewed by an expert GU pathologist. RNA was extracted from 2 x 2.0-mm tumor cores using Qiagen AllPrep DNA/RNA FFPE Kit (Qiagen, Germany) and gene expression was performed on Affymetrix Human Exon 1.0 ST Array (ThermoFischer, CA). PAM50 molecular subtyping was derived using the DecipherGRID database. Results: We profiled 80 tumors from 75 patients, comprising of 18 (24.0%), 9 (12.0%), 21 (28.0%), and 19 (25.3%) NCCN low-/favorable intermediate-, unfavorable intermediate-, high- and very high-RG, respectively; of note, 8 (10.7%) patients had regional/metastatic disease at diagnosis. Using the GC, 27 (33.8%), 14 (17.5%) and 39 (48.8%) were classified as low- (<0.45), intermediate- (0.45-0.6) and high-RG, respectively (>0.6). When stratified using a three-tier clinico-genomic (CG) classification system (Spratt et al. 2017), 6 of 21 (28.6%) NCCN-defined high-risk and 4 of 19 (21.1%) very high-risk patients were downgraded to CG-defined intermediate-/low-risk, while 2 of 27 (7.4%) NCCN low-/intermediate-risk patients were in fact upgraded to CG high-risk. Next, we interrogated the PAM50 basal-luminal signature in our cohort. Interestingly, when matched to White (N = 5762) and non-White (N = 155) for NCCN RG, ISUP GG and age, we observed a high proportion of basal subtype (62.7%) in Asians, which contrasted the prevalence observed in White (16.7%) and non-White (15.9%) North American patients (Chi-sq P <0.001). Conclusions: Here, we demonstrated the utility of the 22-gene GC for refining the NCCN risk stratification in a largest Asian PCa dataset to-date. An unexpectedly high proportion of PAM50 basal-subtype was observed, suggesting race-specific differences of the tumor transcriptome.

Abstract P019: A Single Model For Predicting Major Adverse Cardiovascular Events In Individuals With And Without History Of Atherosclerotic Cardiovascular Disease: The Atherosclerosis Risk In Communities (aric) Study

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Yejin Mok ◽  
Lena Mathews ◽  
Ron C Hoogeveen ◽  
Michael J Blaha ◽  
Christie M Ballantyne ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Disease ◽  
High Risk ◽  
Risk Stratification ◽  
Cardiovascular Events ◽  
Major Adverse Cardiovascular Events ◽  
Atherosclerotic Cardiovascular Disease ◽  
Single Model ◽  
History Of ◽  
Very High

Background: In the 2018 AHA/ACC Cholesterol guideline, risk stratification is an essential element. The use of a Pooled Cohort Equation (PCE) is recommended for individuals without atherosclerotic cardiovascular disease (ASCVD), and the new dichotomous classification of very high-risk vs. high-risk has been introduced for patients with ASCVD. These distinct risk stratification systems mainly rely on traditional risk factors, raising the possibility that a single model can predict major adverse cardiovascular events (MACEs) in persons with and without ASCVD. Methods: We studied 11,335 ARIC participants with (n=885) and without (n=10,450) a history of ASCVD (myocardial infarction, ischemic stroke, and symptomatic peripheral artery disease) at baseline (1996-98). We modeled factors in the PCE and the new classification for ASCVD patients (Figure legend) in a single CVD prediction model. We examined their associations with MACEs (myocardial infarction, stroke, and heart failure) using Cox models and evaluated the discrimination and calibration for a single model including those factors. Results: During a median follow-up of 18.4 years, there were 3,658 MACEs (3,105 in participants without ASCVD). In general, the factors in the PCE and the risk classification system for ASCVD patients were associated similarly with MACEs regardless of baseline ASCVD status, although age and systolic blood pressure showed significant interactions. A single model with these predictors and the relevant interaction terms showed good calibration and discrimination for those with and without ASCVD (c-statistic=0.729 and 0.704, respectively) (Figure). Conclusion: A single CVD prediction model performed well in persons with and without ASCVD. This approach will provide a specific predicted risk to ASCVD patients (instead of dichotomy of very high vs. high risk) and eliminate a practice gap between primary vs. secondary prevention due to different risk prediction tools.

scholarly journals Risk stratification for intestinal dysbiosis in hospitalized adult patients according to the National Dysbiosis Survey (INDIS)

2020 ◽  
Vol 2 (35) ◽  
pp. 149-159
Author(s):  
Aline Okipney ◽  
Jéssica Romanelli Amorim de Souza ◽  
Antonio Carlos Ligocki Campos ◽  
Leticia Fuganti Campos ◽  
Paula Rodrigues Anjo ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Risk Stratification ◽  
Elderly Patients ◽  
Univariate Analysis ◽  
Intestinal Flora ◽  
Adult Patients ◽  
Therapeutic Interventions ◽  
Intestinal Dysbiosis ◽  
Very High

Introduction: The intestinal microbiota has a symbiotic relationship with the human being. Its alteration, known as dysbiosis, can result in several diseases. Some risk factors may predict the occurrence of this condition. The purpose of this study was to evaluate the effectiveness of the National Dysbiosis Survey (INDIS) in the risk stratification of hospitalized adult patients that presented with intestinal dysbiosis. Methods: 100 patients hospitalized at the Hospital das Clínicas da UFPR were interviewed through INDIS. In this questionnaire, risk factors for dysbiosis of each patient were established and the dysbiosis degree was stratified in low, medium, high, and very high risk. Results: Most patients were classified as medium (43%) and high risk (39%) of dysbiosis. The univariate analysis revealed an association between the degree of dysbiosis and elderly patients (p=0.034), number of comorbidities (p<0.001), presence of diarrhea or constipation (p<0.001) and medication in use [antibiotic and/or proton pump inhibitor (PII); p<0.001]. In the multivariate analysis, the most important influence in classification was the presence of diarrhea or constipation (OR=3.00, 95% CI [1.73, 5.21] p<0.001) and medication in use (Score 3: OR = 53.4, 95% CI [2.73, 1045.5], p=0.009 and Score 4-8: OR = 1709.1, 95% CI [50.27, 58103.5] p<0.001), both independent predictors of high and very high risk of dysbiosis. Conclusion: The risk degree of intestinal dysbiosis is greater in the presence of diarrhea or constipation, the use of antibiotics and/or PII, and in elderly patients. Once the risks of dysbiosis have been defined, INDIS proved to be an effective and rapid tool for risk stratification of dysbiosis in the study population, future studies should determine the relevance of therapeutic interventions with the purpose of normalizing the intestinal flora.

Cardiovascular risk assessment in diabetes and pre-diabetes

ESC CardioMed ◽  
2018 ◽  
pp. 923-924
Author(s):  
Nikolaus Marx
Keyword(s):  
Risk Assessment ◽  
Cardiovascular Risk ◽  
High Risk ◽  
Target Organ Damage ◽  
Risk Scores ◽  
High Risk Patients ◽  
Patients With Diabetes ◽  
Risk Patients ◽  
Artery Disease ◽  
Very High

Patients with diabetes exhibit an increased propensity to develop cardiovascular disease with an increased mortality. Early risk assessment, especially for coronary artery disease, is important to initiate therapeutic strategies to reduce cardiovascular risk. This chapter reviews the current literature on risk scores in patients with type 1 and type 2 diabetes and summarizes the role of risk assessment based on biomarkers and different imaging strategies. Current guidelines recommend that patients with diabetes are characterized as high-risk or very high-risk patients. In the presence of target organ damage or other risk factors such as smoking, marked hypercholesterolaemia, or hypertension, patients with diabetes are classified as very high-risk patients while most other people with diabetes are categorized as high-risk patients.

scholarly journals Successful Model for Guideline Implementation to Prevent Cancer-Associated Thrombosis: Venous Thromboembolism Prevention in the Ambulatory Cancer Clinic

2020 ◽  
Vol 16 (9) ◽  
pp. e868-e874 ◽  
Author(s):  
Chris E. Holmes ◽  
Steven Ades ◽  
Susan Gilchrist ◽  
Daniel Douce ◽  
Karen Libby ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Venous Thromboembolism ◽  
High Risk ◽  
Assessment Tool ◽  
Guideline Implementation ◽  
Vte Prophylaxis ◽  
Successful Model ◽  
Venous Thromboembolism Prevention ◽  
Risk Patients ◽  
Cancer Associated Thrombosis

PURPOSE: Guidelines recommend venous thromboembolism (VTE) risk assessment in outpatients with cancer and pharmacologic thromboprophylaxis in selected patients at high risk for VTE. Although validated risk stratification tools are available, < 10% of oncologists use a risk assessment tool, and rates of VTE prophylaxis in high-risk patients are low in practice. We hypothesized that implementation of a systems-based program that uses the electronic health record (EHR) and offers personalized VTE prophylaxis recommendations would increase VTE risk assessment rates in patients initiating outpatient chemotherapy. PATIENTS AND METHODS: Venous Thromboembolism Prevention in the Ambulatory Cancer Clinic (VTEPACC) was a multidisciplinary program implemented by nurses, oncologists, pharmacists, hematologists, advanced practice providers, and quality partners. We prospectively identified high-risk patients using the Khorana and Protecht scores (≥ 3 points) via an EHR-based risk assessment tool. Patients with a predicted high risk of VTE during treatment were offered a hematology consultation to consider VTE prophylaxis. Results of the consultation were communicated to the treating oncologist, and clinical outcomes were tracked. RESULTS: A total of 918 outpatients with cancer initiating cancer-directed therapy were evaluated. VTE monthly education rates increased from < 5% before VTEPACC to 81.6% (standard deviation [SD], 11.9; range, 63.6%-97.7%) during the implementation phase and 94.7% (SD, 4.9; range, 82.1%-100%) for the full 2-year postimplementation phase. In the postimplementation phase, 213 patients (23.2%) were identified as being at high risk for developing a VTE. Referrals to hematology were offered to 151 patients (71%), with 141 patients (93%) being assessed and 93.8% receiving VTE prophylaxis. CONCLUSION: VTEPACC is a successful model for guideline implementation to provide VTE risk assessment and prophylaxis to prevent cancer-associated thrombosis in outpatients. Methods applied can readily translate into practice and overcome the current implementation gaps between guidelines and clinical practice.

scholarly journals Risk-assessment models for VTE and bleeding in hospitalized medical patients: an overview of systematic reviews

2020 ◽  
Vol 4 (19) ◽  
pp. 4929-4944
Author(s):  
Andrea J. Darzi ◽  
Allen B. Repp ◽  
Frederick A. Spencer ◽  
Rami Z. Morsi ◽  
Rana Charide ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Systematic Reviews ◽  
Risk Of Bias ◽  
Clinical Expertise ◽  
Medical Patients ◽  
Vte Prophylaxis ◽  
Risk Assessment Models ◽  
Medical Inpatients ◽  
Overview Of Systematic Reviews

Abstract Multiple risk-assessment models (RAMs) for venous thromboembolism (VTE) in hospitalized medical patients have been developed. To inform the 2018 American Society of Hematology (ASH) guidelines on VTE, we conducted an overview of systematic reviews to identify and summarize evidence related to RAMs for VTE and bleeding in medical inpatients. We searched Epistemonikos, the Cochrane Database, Medline, and Embase from 2005 through June 2017 and then updated the search in January 2020 to identify systematic reviews that included RAMs for VTE and bleeding in medical inpatients. We conducted study selection, data abstraction and quality assessment (using the Risk of Bias in Systematic Reviews [ROBIS] tool) independently and in duplicate. We described the characteristics of the reviews and their included studies, and compared the identified RAMs using narrative synthesis. Of 15 348 citations, we included 2 systematic reviews, of which 1 had low risk of bias. The reviews included 19 unique studies reporting on 15 RAMs. Seven of the RAMs were derived using individual patient data in which risk factors were included based on their predictive ability in a regression analysis. The other 8 RAMs were empirically developed using consensus approaches, risk factors identified from a literature review, and clinical expertise. The RAMs that have been externally validated include the Caprini, Geneva, IMPROVE, Kucher, and Padua RAMs. The Padua, Geneva, and Kucher RAMs have been evaluated in impact studies that reported an increase in appropriate VTE prophylaxis rates. Our findings informed the ASH guidelines. They also aim to guide health care practitioners in their decision-making processes regarding appropriate individual prophylactic management.

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