scholarly journals GPs’ familiarity with and use of cardiovascular clinical prediction rules: a UK survey study

BJGP Open ◽  
2020 ◽  
Vol 4 (5) ◽  
pp. bjgpopen20X101081
Author(s):  
Jong-Wook Ban ◽  
Rafael Perera ◽  
Richard Stevens
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Survey Study ◽  
Risk Scores ◽  
Clinical Prediction ◽  
Clinical Prediction Rules ◽  
Prediction Rules ◽  
Vein Thrombosis ◽  
The Uk ◽  
Deep Vein

BackgroundClinical prediction rules (CPRs) can help general practitioners (GPs) address challenges in cardiovascular disease. A survey published in 2014 evaluated GPs’ awareness and use of CPRs in the UK. However, many new CPRs have been published since and it is unknown which cardiovascular CPRs are currently recognised and used.AimTo identify cardiovascular CPRs recognised and used by GPs, and to assess how GPs’ familiarity and use have changed over time.Design & settingAn online survey of GPs in the UK was undertaken.MethodUsing comparable methods to the 2014 survey, GPs were recruited from a network of doctors in the UK. They were asked how familiar they were with cardiovascular CPRs, how frequently they used them, and why they used them. The results were compared with the 2014 survey.ResultsMost of 401 GPs were familiar with QRISK scores, ABCD scores, CHADS scores, HAS-BLED score, Wells scores for deep vein thrombosis, and Wells scores for pulmonary embolism. The proportions of GPs using these CPRs were 96.3%, 65.1%, 97.3%, 93.0%, 92.5%, and 82.0%, respectively. GPs’ use increased by 31.2% for QRISK scores, by 13.5% for ABCD scores, by 54.6% for CHADS scores, by 33.2% for Wells scores for deep vein thrombosis, and by 43.6% for Wells scores for pulmonary embolism; and decreased by 45.9% for the Joint British Societies (JBS) risk calculator, by 38.7% for Framingham risk scores, and by 8.7% for New Zealand tables. GPs most commonly used cardiovascular CPRs to guide therapy and referral.ConclusionThe study found GPs’ familiarity and use of cardiovascular CPRs changed substantially. Integrating CPRs into guidelines and practice software might increase familiarity and use.

Risk Assessment Model to Predict Recurrence in Patients with Unprovoked Deep Vein Thrombosis or Pulmonary Embolism.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 452-452
Author(s):  
Sabine Eichinger ◽  
Georg Heinze ◽  
Paul Alexander Kyrle
Keyword(s):  
Risk Assessment ◽  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Recurrence Risk ◽  
Assessment Model ◽  
Risk Scores ◽  
Risk Assessment Model ◽  
Vein Thrombosis ◽  
Deep Vein ◽  
D Dimer

Abstract Abstract 452 Background: Venous thrombosis is a chronic and potentially fatal disease (case fatality 5-9%). Predicting the likelihood of recurrence is important, as most recurrences can be prevented by antithrombotic therapy, albeit at the price of an increased bleeding risk during anticoagulation. Despite a substantial progress in identifying the determinants of the recurrence risk, predicting recurrence in an individual patient is often not feasible. Venous thromboembolism (VTE) is a multicausal disease and the combined effect of clinical and laboratory factors on the recurrence risk is unknown. It was the aim of our study to develop a simple risk model that improves prediction of the recurrence risk in patients with unprovoked VTE. Methods and Findings: In a prospective multicenter cohort study we followed 929 patients with a first VTE after completion of at least 3 months of anticoagulation. The median observation time was 43.3 months. Patients with VTE provoked by surgery, trauma, cancer, pregnancy or oral contraceptive intake were excluded as were those with a natural inhibitor deficiency or the lupus anticoagulant. The main outcome measure was symptomatic recurrent VTE, which occurred in 176 patients. The probability of recurrence (95% CI) after 2, 5 and 10 years was 13.8% (11.6% to16.5%), 24.6% (21.6% to 28.9%), and 31.8% (27.6% to 37.4%), respectively. To develop a simple and easy to apply risk assessment model, clinical and laboratory variables (age, sex, location of VTE, body mass index, factor V Leiden, prothrombin G20210A mutation, D-Dimer, in vitro thrombin generation) were preselected based on their established relevance for the recurrence risk, simple assessment, and reproducibility. All variables were analyzed in a Cox proportional hazards model, and those significantly associated with recurrence were used to compute risk scores. Only male sex [HR vs. female 1.90 (95% CI 1.31–2.75)], proximal deep vein thrombosis [HR vs. distal 2.08 (95% CI 1.16–3.74)], pulmonary embolism [HR vs. distal thrombosis 2.60 (95% CI 1.49– 4.53)] and elevated levels of D-Dimer [HR per doubling 1.27 (95% CI 1.08–1.51)] or peak thrombin [HR per 100 nM increase 1.38 (95% CI 1.17–1.63)] were related to a higher recurrence risk. We developed a nomogram (Fig. 1) based on sex, location of initial thrombosis, and D-Dimer that can be used to calculate risk scores and to estimate the cumulative probabilities of recurrence in an individual patient. The model has undergone extensive validation by a cross-validation process. The cohort was divided into test and validation samples thereby mimicking independent validation. This process was repeated 1000 times and the results were averaged to avoid dependence of the validation results on a particular partition of our cohort. Patients were assigned to different risk categories according to their risk score, which corresponded well with the recurrence rate as patients with lower scores had lower recurrence rates. Conclusion: By use of a simple scoring system the assessment of the recurrence risk in patients with a first unprovoked VTE can be improved in routine care. Patients with unprovoked VTE in whom the recurrence risk is low enough to consider a limited duration of anticoagulation, can be identified. Disclosures: No relevant conflicts of interest to declare.

Diagnosis: clinical prediction rules and laboratory tests

ESC CardioMed ◽  
2018 ◽  
pp. 2758-2761
Author(s):  
Piotr Pruszczyk
Keyword(s):  
Pulmonary Embolism ◽  
High Probability ◽  
Clinical Manifestations ◽  
High Sensitivity ◽  
Clinical Prediction ◽  
Clinical Prediction Rules ◽  
Prediction Rules ◽  
Vein Thrombosis ◽  
Clinical Probability ◽  
D Dimer

Clinical manifestations of venous thromboembolism (VTE) usually are non-specific. In order to facilitate proper diagnosis, clinical prediction rules were derived. The best studied models are the Wells criteria for deep vein thrombosis and pulmonary embolism and the Geneva score for pulmonary embolism. They classify patients into different categories of clinical pretest VTE probability. Pulmonary embolism prevalence is approximately 10% in low-, 30% in moderate-, and up to 65% in high-probability categories. Plasma D-dimer levels are elevated in not only VTE but also in other conditions. A D-dimer assay should be used in combination with pretest VTE clinical probability. A normal high-sensitivity D-dimer level excludes pulmonary embolism in patients with low/intermediate or non-high VTE probability, while in the high probability category does not allow VTE to be safely excluded. Age-adjusted D-dimer thresholds (age × 10 μ‎g/L above 50 years) can limit the need for imaging methods without increasing the rate of missed diagnoses in non-high clinical probability patients.

Urokinase Treatment In Acute And Subacute Deep Vein Thrombosis

1981 ◽  
Author(s):  
G Trübestein ◽  
Th Brecht ◽  
M Ludwig ◽  
G Brecht ◽  
F Etzel
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Side Effects ◽  
Initial Dose ◽  
Fibrinolytic Therapy ◽  
Thrombin Time ◽  
Vein Thrombosis ◽  
The Uk ◽  
Deep Vein ◽  
Medium Dose

So far 74 patients with acute and subacute Deep Vein Thrombosis (DVT) were treated with a standardized Urokinase (UK) heparin scheme. From these patients 19 patients had a 1-6 day and 55 patients a 1-6 week old thrombosis of the iliac, femoral, popliteal or subclavian veins. The initial dose of the UK regimen was mostly 250.000 IU UK/10 min; the maintenance dose was 1.000.000 IU UK/24h in 40 patients, 1.500.000 IU UK/24h in 12 patients and 2.000.000 IU UK/24h in 22 patients. Heparin was given from the very beginning, starting with a dose of 1.000 IU/h. In the further course of therapy heparin was adjusted so that the thrombin time was 2 to 4 times of the normal. The duration of fibrinolytic therapy was mostly between 3 and 6 days in acute and between 7 and 14 days in subacute DVT. Severe side effects were seen in 2 patients, who had a strong bleeding. One patient died of pulmonary embolism.Results: The 1-6 day old thromboses of the 19 patients could be dissolved completely in 7 patients (37%) and partially in 4 patients (21%); no amelioration in the phlebo- grams was found in 8 patients (42%). The 1-6 week old thromboses of the 55 patients could be dissolved completely in 9 patients (16%) and partially in 30 patients (55%); no amelioration in the phlebograms was found in 16 patients (29%).Conclusion: The standardized UK-heparin scheme with a medium dose 80.000 IU UK/h used by us proved to be effective in most patients with DVT.

Risk of deep vein thrombosis and pulmonary embolism after acute infection in a community setting

The Lancet ◽  
2006 ◽  
Vol 367 (9516) ◽  
pp. 1075-1079 ◽  
Author(s):  
Liam Smeeth ◽  
Claire Cook ◽  
Sara Thomas ◽  
Andrew J Hall ◽  
Richard Hubbard ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Acute Infection ◽  
Community Setting ◽  
Vein Thrombosis ◽  
Deep Vein

Incidence of venous thromboembolism among patients receiving neoadjuvant chemotherapy for advanced epithelial ovarian cancer

2020 ◽  
Vol 30 (4) ◽  
pp. 491-497 ◽  
Author(s):  
Julia Rose Salinaro ◽  
Kourtnie McQuillen ◽  
Megan Stemple ◽  
Robert Boccaccio ◽  
Jessie Ehrisman ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Venous Thromboembolism ◽  
Adjuvant Chemotherapy ◽  
Neoadjuvant Chemotherapy ◽  
Epithelial Ovarian Cancer ◽  
Primary Outcome ◽  
Vein Thrombosis ◽  
Deep Vein

ObjectivesNeoadjuvant chemotherapy may be considered for women with epithelial ovarian cancer who have poor performance status or a disease burden not amenable to primary cytoreductive surgery. Overlap exists between indications for neoadjuvant chemotherapy and known risk factors for venous thromboembolism, including impaired mobility, increasing age, and advanced malignancy. The objective of this study was to determine the rate of venous thromboembolism among women receiving neoadjuvant chemotherapy for epithelial ovarian cancer.MethodsA multi-institutional, observational study of patients receiving neoadjuvant chemotherapy for primary epithelial ovarian, fallopian tube, or peritoneal cancer was conducted. Primary outcome was rate of venous thromboembolism during neoadjuvant chemotherapy. Secondary outcomes included rates of venous thromboembolism at other stages of treatment (diagnosis, following interval debulking surgery, during adjuvant chemotherapy, or during treatment for recurrence) and associations between occurrence of venous thromboembolism during neoadjuvant chemotherapy, subject characteristics, and interval debulking outcomes. Venous thromboembolism was defined as deep vein thrombosis in the upper or lower extremities or in association with peripherally inserted central catheters or ports, pulmonary embolism, or concurrent deep vein thrombosis and pulmonary embolism. Both symptomatic and asymptomatic venous thromboembolism were reported.ResultsA total of 230 patients receiving neoadjuvant chemotherapy were included; 63 (27%) patients overall experienced a venous thromboembolism. The primary outcome of venous thromboembolism during neoadjuvant chemotherapy occurred in 16 (7.7%) patients. Of the remaining venous thromboembolism events, 22 were at diagnosis (9.6%), six post-operatively (3%), five during adjuvant chemotherapy (3%), and 14 during treatment for recurrence (12%). Patients experiencing a venous thromboembolism during neoadjuvant chemotherapy had a longer mean time to interval debulking and were less likely to undergo optimal cytoreduction (50% vs 80.2%, p=0.02).ConclusionsPatients with advanced ovarian cancer are at high risk for venous thromboembolism while receiving neoadjuvant chemotherapy. Consideration of thromboprophylaxis may be warranted.

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