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.

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.

Prevalence of Risk Factors for VTE In Hospitalized Medical and Surgical Patients. Data From the Comparison of Methods for Thromboembolic Risk Assessment with Clinical Perceptions and AwareneSS In Real Life Surgical and Medical Patients (COMPASS) Study

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3337-3337
Author(s):  
Grigoris T Gerotziafas ◽  
Miltos Chrysanthidis ◽  
Reda Isaad ◽  
Hela Baccouche ◽  
Chrysoula Papageorgiou ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Gastrointestinal Disease ◽  
Real Life ◽  
Bleeding Risk ◽  
Hospitalized Patients ◽  
Assessment Model ◽  
Surgical Patients ◽  
Medical Patients ◽  
The Impact

Abstract Abstract 3337 Introduction: Risk assessment models (RAM) are helpful tools for the screening VTE risk in hospitalized patients. Most of the available RAMs have been constructed on a disease-based or surgery-based approach and include some of the most relevant risk factors for VTE. There is limited information on the impact and importance of individual and comorbidity related risk factors for VTE present during hospitalization on the global VTE risk. Incorporation of the most frequent VTE risk and bleeding risk factors related to comorbidities might improve the ability of RAM to detect real-life patients at risk VTE and to evaluate drawbacks for the application of thromboprophylaxis. Aim of the study: The primary aim of the COMPASS programme was to evaluate the prevalence of the all known VTE and bleeding risk factors reported in the literature in real-life surgical and medical hospitalized patients. Methods: A prospective multicenter cross-sectional observational study was conducted in 6 hospitals in Greece and 1 in France. All inpatients aged >40 years hospitalised for medical diseases and inpatients aged >18 years admitted due to a surgical procedure and hospitalisation for a period exceeding three days were included. Patients and their treating physicians were interviewed with standardised questionnaire including all VTE and bleeding risk factors described in literature (130 items) on the third day of hospitalisation. Patients not giving informed consent, or receiving anticoagulant treatment for any reason or hospitalised in order to undergo diagnostic investigation without any further therapeutic intervention were excluded. Results: A total of 806 patients were enrolled in the study (414 medical and 392 surgical). Most frequent causes of hospitalisation in medical patients were infection (42%), ischemic stroke (14%), cancer (13%), gastrointestinal disease (9%), pulmonary disease (4%), renal disease (3%) and rheumatologic disease (1,4%). Surgical patients were hospitalised for vascular disease (22%) cancer (19,4%) gastrointestinal disease (12,5%), infection (8%), orthopaedic surgery and trauma (14%) or minor surgery (7%). Analysis of the frequency of risk factors for VTE showed that active cancer, recent hospitalisation, venous insufficiency and total bed rest without bathroom privileges were frequent in both groups. Medical patients had significantly more frequently than surgical patients several important predisposing risk factors for VTE. Moreover, medical patient had more frequently than surgical ones bleeding risk factors. The data for the most frequent risk factors are summarised in Table 1. Conclusion: COMPASS is the first registry that provides key data on the prevalence of all known VTE and bleeding risk factors in real life medical and surgical patients hospitalised in two countries of European Union. The analysis of the data shows that in addition to risk stemin from the disease or surgical act both medical and surgical patients share common VTE risk factors. The careful analysis of the most frequent and relevant VTE risk factors will allow the derivation of a practical VTE and bleeding risk assessment model taken into account these factors. Disclosures: Chrysanthidis: Sanofi-Aventis: Employment.

External validation of the IMPROVE Bleeding Risk Assessment Model in medical patients

2016 ◽  
Vol 116 (09) ◽  
pp. 530-536 ◽  
Author(s):  
David J. Rosenberg ◽  
Anne Press ◽  
Joanna Fishbein ◽  
Martin Lesser ◽  
Lauren McCullagh ◽  
...  
Keyword(s):  
Risk Assessment ◽  
High Risk ◽  
High Risk Patient ◽  
Assessment Model ◽  
Risk Assessment Model ◽  
Validation Sample ◽  
Medical Patients ◽  
Medically Ill ◽  
Major Bleed ◽  
Hospitalised Patients

SummaryThe IMPROVE Bleed Risk Assessment Model (RAM) remains the only bleed RAM in hospitalised medical patients using 11 clinical and laboratory factors. The aim of our study was to externally validate the IMPROVE Bleed RAM. A retrospective chart review was conducted between October 1, 2012 and July 31, 2014. We applied the point scoring system to compute risk scores for each patient in the validation sample. We then dichotomised the patients into those with a score <7 (low risk) vs ≥ 7 (high risk), as outlined in the original study, and compared the rates of any bleed, non-major bleed, and major bleed. Among the 12,082 subjects, there was an overall 2.6 % rate of any bleed within 14 days of admission. There was a 2.12 % rate of any bleed in those patients with a score of < 7 and a 4.68 % rate in those with a score ≥ 7 [Odds Ratio (OR) 2.3 (95 % CI=1.8–2.9), p<0.0001]. MB rates were 1.5 % in the patients with a score of < 7 and 3.2 % in the patients with a score of ≥ 7, [OR 2.2 (95 % CI=1.6–2.9), p<0.0001]. The ROC curve was 0.63 for the validation sample. This study represents the largest externally validated Bleed RAM in a hospitalised medically ill patient population. A cut-off point score of 7 or above was able to identify a high-risk patient group for MB and any bleed. The IMPROVE Bleed RAM has the potential to allow for more tailored approaches to thromboprophylaxis in medically ill hospitalised patients.Supplementary Material to this article is available online at www.thrombosis-online.com.

scholarly journals Application of the Caprini Risk Assessment Model for the Assessment of Risk Factors for Postoperative Venous Thromboembolism in the Surgery Department of Anosiala University Hospital

2021 ◽  
Vol 2 (3) ◽  
pp. 1-7
Author(s):  
Jean Baptiste Ramampisendrahova ◽  
Andriamanantsialonina Andrianony ◽  
Aina Andrianina Vatosoa Rakotonarivo ◽  
Mamisoa Bodohasina Rasamoelina ◽  
Eric Andriantsoa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Assessment Model ◽  
University Hospital ◽  
Risk Category ◽  
Risk Assessment Model ◽  
Moderate Risk ◽  
Risk Patients ◽  
Surgery Department

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.

Venous Thromboembolism Validation Study of the IMPROVE Risk Assessment Models in the Medical Patient (VTE-VALOURR),

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4218-4218 ◽  
Author(s):  
Charles Edward Mahan ◽  
Yang Liu ◽  
James D. Douketis ◽  
Alexander G.G. Turpie ◽  
Undaleeb Dairkee ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Venous Thromboembolism ◽  
High Risk ◽  
Validation Study ◽  
Controlled Trials ◽  
Medical Patients ◽  
Control Cohort ◽  
Randomized Controlled ◽  
Risk Assessment Models

Abstract Abstract 4218 Introduction. Venous Thromboembolism (VTE) remains the most common cause of preventable death in hospitalized patients despite more than 25 guidelines and over 5 decades of data on VTE prevention. American College of Chest Physicians (ACCP) and International Union of Angiology (IUA) guideline recommendations are primarily based off of risk factors utilized for entry into randomized controlled trials (RCT) or post-hoc analysis of these RCTs. These guidelines recommend a group-based, as opposed to an individualized risk assessment, approach. It is currently unknown how these risk factors interact in a quantitative manner. There are currently no weighted, validated, VTE risk assessment models (RAM) that are data-derived in medical patients. A retrospective VTE RAM (IMPACT ILL) was recently derived from the multinational IMPROVE registry in hospitalized medical patients. (Table 1) The “VTE-VALOURR ” is a retrospective, multi-center, case control, validation study of this RAM. The VTE-VALOURR is also assessing other VTE and bleeding risk factors. Methods. ICD-10 reports and the McMaster Transfusion Registry for Utilization Surveillance and Tracking (TRUST) database, which contains demographics, transfusion data, and approximately 50 clinical variables including thrombotic outcomes of inpatients, were used as the data source at 3 hospitals. Inclusion criteria were hospitalized medical patients ≥ 18 years with ≥ 3 days length of stay (LOS). Exclusion criteria were patients with pregnancy, mental health disorders, atrial fibrillation/ flutter, trauma, spinal cord injury, surgery within 90 days, VTE within 24 hours of admission, treatment dose anticoagulants (including warfarin) within 48 hours of admission, or transferred from a non-McMaster acute care facility. Lower extremity deep vein thrombosis (DVT) and pulmonary embolism out to 90 days post admission were the thrombotic outcomes of interest and verified by chart review. Upper extremity DVT was excluded. Descriptive statistics (proportions and frequencies) were used to summarize binary variables. Results. From January 1st, 2005 to February 28th, 2011, 247,241 hospitalizations occurred at 3 McMaster hospitals. After exclusionary criteria were applied, 779 VTE events were identified. (Figure 1) Of these, 419 were excluded because they were VTE events not related to a previous hospitalization (i.e. community-acquired). Of the remaining 360 patients, 240 have been reviewed with 93 confirmed, included, VTE events having occurred, 147 events being further excluded, and another 120 patients still requiring review. We present an interim analysis of the 93 currently included patients. Of the included patients, 68 (73%) received some form of prophylaxis during their hospital stay while 35 (38%) received appropriate type, dose and duration of prophylaxis. Fifty-eight (62%) of VTE events were therefore “preventable.” Number of risk factors per patient and risk scores for the 93 patients are listed in tables 2 and 3. Conclusions. Validation of this VTE RAM will identify medical patients at risk of VTE that do not readily fit into group-specific VTE risk categories. Additionally, validation will identify subsets of patients at especially high risk of VTE and focus future randomized controlled trials. Other VTE risk factors may be identified with the study. Review of the 120 VTE cohort patients needs to be completed as well as review of a comparator control cohort. Approximately 80% of the current VTE cohort appears to have a score of 2 or above and be at moderate to high risk of VTE. Final results of approximately 150 VTE patients will be presented along with the control cohort as well as if the model is valid. Disclosures: Turpie: Astellas Pharma Europe: Consultancy; Bayer HealthCare AG: Consultancy; Portola Pharma: Consultancy; sanofi-aventis: Consultancy.

scholarly journals The HAS-RISC Score for Venous Thromboembolism (VTE) Risk Stratification in Newly Diagnosed Multiple Myeloma Patients Starting Immunomodulatory Drugs (IMID)

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 144-144 ◽  
Author(s):  
Ang Li ◽  
Qian V. Wu ◽  
Greg Warnick ◽  
Neil A Zakai ◽  
Edward N. Libby ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
High Risk ◽  
Research Funding ◽  
Risk Group ◽  
High Risk Group ◽  
Assessment Model ◽  
Risk Assessment Model ◽  
Newly Diagnosed ◽  
Very High

Abstract Introduction: Patients with newly diagnosed multiple myeloma (MM) have high risk of venous thromboembolism (VTE) when starting initial treatment that contains immunomodulatory drugs (IMID) such as lenalidomide or thalidomide. The National Comprehensive Cancer Network (NCCN) guideline recommends primary anticoagulant thromboprophylaxis for the high-risk patients. However, it is challenging to risk-stratify patients without a validated risk model. We have conducted a retrospective cohort study using the SEER-Medicare (Surveillance, Epidemiology, and End Results) database to derive a new VTE risk assessment model. Methods: We selected all patients 66 or older with newly diagnosed MM 2007 to 2013. Patients were included if they had a prescription of IMID within twelve months of diagnosis and complete enrollment for fee-for-service and prescription drug coverage. We ascertained baseline demographics and VTE risk factors from the current NCCN guideline using validated codes. The VTE outcome was defined as either one inpatient or two outpatient claims at least 30 days apart in combination with an anticoagulant prescription within 90 days. All patients were followed from the date of IMID initiation until first VTE occurrence or death and were censored for disenrollment from Medicare, discontinuation of IMID (after a grace period of 90 days), autologous transplantation, or the end of claims data (12/31/2014). Cause specific Cox regression models were used for time to VTE analysis. For variable selection, all risk factors with p-value <0.10 were considered candidates for inclusion in the final multivariable regression model. VTE history, recent surgery, and anticoagulant exposure were forced into the model, regardless of significance testing. Integer points were assigned according to the beta coefficients and subsequent risk groups were created. The model's discrimination was validated internally by the bias-corrected Harrell's c statistic and the 95% confidence interval was estimated from 200 bootstrap samples. Results: We identified 2397 MM patients on IMID that met the study criteria. The median time on IMID treatment was 116 days (IQR 28-279). The mean age of patients was 74, 49% were female, 80% were White, 13% were Black, 6.5% were Asian. Only 13% of patients had concurrent anticoagulant exposure (11% warfarin, 2% LMWH, 1% DOAC) with a median duration of 116 days (IQR 42-315 days). In the multivariable model built from candidate covariates, we identified history of VTE, recent surgery, cytotoxic (non-bortezomib) chemotherapy, higher dose dexamethasone, older age, and Black race, as important risk factors. Asian race and LMWH/DOAC use were associated with lower VTE risk (Table 1). We derived a risk assessment model that stratified patients into 2 prognostic risk groups (Table 1): 25% (n=581) in the very high-risk group (score 2 to 7), 75% (n=1816) in the standard-risk group (score -3 to 1). The incidence of VTE at 3 months and 6 months were 9.5% and 16.3% in the very high-risk group compared to 3.7% and 6.3% in the standard-risk group with a resulting hazard ratio of 2.73 (p<0.001) (Figure 1). The bias-corrected Harrell's c statistic for the product index was 0.63 (0.59-0.68). Conclusions: We have derived a VTE risk assessment model specifically for patients with MM starting IMID therapy. The HAS-RiSC score combines 7 clinical risk factors - History of VTE, Age 80+, Surgery within last 90 days, Race Black, race Asian, Steroid use, and Chemotherapy - into a simplified VTE risk assessment model that identifies a subgroup of patients at very high risk for VTE. External validation of this risk assessment model is currently in progress. Disclosures Garcia: Daiichi Sankyo: Research Funding; Incyte: Research Funding; Janssen: Consultancy, Research Funding; Pfizer: Consultancy; Retham Technologies LLC: Consultancy; Shingoi: Consultancy; Portola: Research Funding; Bristol Meyers Squibb: Consultancy; Boehringer Ingelheim: Consultancy. Lyman:Amgen: Other: Research support; Generex Biotechnology: Membership on an entity's Board of Directors or advisory committees; Halozyme; G1 Therapeutics; Coherus Biosciences: Consultancy.

Impact of Venous Thromboembolism (VTE) Prophylaxis and Risk Stratification with the Caprini Model in Hospitalized Patients with Cancer

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 364-364
Author(s):  
Joshua M Ruch ◽  
Hsou M Hu ◽  
Vinita Bahl ◽  
Suman L. Sood
Keyword(s):  
Risk Assessment ◽  
High Risk ◽  
Conflicts Of Interest ◽  
Assessment Model ◽  
Risk Assessment Model ◽  
Medical Patients ◽  
Vte Prophylaxis ◽  
Patients With Cancer ◽  
Pharmacologic Prophylaxis ◽  
The Impact

Abstract Abstract 364 Introduction: VTE is a common complication in hospitalized medical patients and the role of pharmacologic anticoagulation prophylaxis is well-established. Patients with active malignancy are at higher risk for VTE during hospitalization. However, VTE prophylaxis is underutilized in these patients due to many real and perceived contraindications to prophylaxis. To aid clinicians in determining VTE risk and guide choice of prophylaxis, our institution adopted the Caprini risk assessment model (Ann Surg, 2010; 251[2]:344–50), based on clinical factors such as age, comorbidities, and recent surgery. Our primary objective was to assess adherence to recommended VTE prophylaxis in hospitalized medical patients with solid tumors, hematological malignancies, and bone marrow transplant (BMT) patients in comparison to general medical (GM) patients, and the impact of recommended prophylaxis use on VTE outcomes. Secondary objectives were to evaluate the distribution of Caprini risk scores and the utility of the Caprini risk assessment model for guiding prophylaxis in this population. Methods: Patients admitted to the hematology/oncology (HO; oncology, malignant hematology, and BMT) and GM inpatient services at the University of Michigan between July 1, 2009 to December 31, 2011 were included in the study. After IRB approval, patient information was extracted from the electronic medical record (EMR). A point-scoring method based on the Caprini risk assessment model was used to calculate VTE risk at admission. A score of 3–4 was high risk and ≥ 5 highest risk for VTE. Type of VTE prophylaxis and VTE rate were determined. Recommended prophylaxis was 5000 units TID SQ heparin, 30–40 mg SQ enoxaparin, or 2.5 mg SQ fondaparinux, ± sequential compression devices (SCDs). Pharmacological prophylaxis administration was verified in the EMR. VTE is defined as deep venous thrombosis (DVT) or pulmonary embolism (PE) occurring during hospitalization or within 90 days, confirmed by Doppler, CT or V/Q scan. Adherence was defined as the percentage of patients at high or highest risk for VTE with a length of stay ≥ 2 days who received guideline recommended prophylaxis within 2 days of admission. Patients with a contraindication to prophylaxis were excluded. A retrospective cohort study was performed. Chi-squared test was used to test differences in proportions and Cochran-Armitage test for trends. Results: 4300 patients were admitted to HO and 18,347 to GM services. Compared to GM patients (86.8%), the rate of adherence to recommended VTE prophylaxis was similar for oncology (87.6%), hematology (85.4%), and lower (45.6%) for BMT patients (p<0.0001). The overall VTE rate on HO services was 2.77%. Compared with 1.45% in GM, VTE rate was 3.02% in oncology (p=0.070), 2.01% in hematology (p=0.220), and 3.61% for BMT (p=0.001). Over half (51.3%) of VTE in HO patients occurred in patients who did not receive pharmacologic prophylaxis. In HO patients with a VTE, ordered prophylaxis included 16.0% combined pharmacological and SCD, 32.8% pharmacological alone, 32.8% SCD alone, and 18.5% none. Use of combined or pharmacologic prophylaxis alone was non-significantly increased in the non-VTE HO patients. By the Caprini risk assessment model, 33.3% of all patients on HO services were high and 62.2% highest risk, with less oncology (p=0.0001) and more BMT (p=0.0003) patients classified as high or highest risk. VTE rate in HO patients rose as Caprini risk score increased: score (n, % with VTE) 0–1 (23, 4.35%,); 2 (169, 0.59%); 3–4 (1434, 1.67%); 5–6 (1691, 2.90%); 7–8 (745, 3.76%); and 9 (238, 6.72%), p<0.0001 for trend. Conclusions: Adherence to recommended VTE prophylaxis was high in medical patients with cancer, resulting in low overall rates of VTE during and following discharge. The majority of patients with VTE did not receive recommended pharmacologic prophylaxis. Most VTE occurred in patients at highest risk (Caprini risk assessment score ≥ 5), with a trend to higher VTE rate as individual score increased. These data suggest that the individual Caprini score may provide more detailed VTE risk assessment and may help inform the need for prophylaxis despite perceived relative contraindications in this high risk cancer population. Further study is needed to understand the barriers to ordering VTE prophylaxis in this population and encourage increased prophylaxis use. Disclosures: No relevant conflicts of interest to declare.

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