Marc Blondon1, David Spirk2, Nils Kucher3, Drahomir Aujesky4, Daniel Hayoz5, Jürg H Beer6, Marc Husmann7, Beat Frauchiger8, Wolfgang Korte9, Walter A Wuillemin10, Henri Bounameaux1, Marc Righini1, Mathieu Nendaz11. 1. Division of Angiology and Hemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland. 2. Institute of Pharmacology, University of Bern, Bern, Switzerland. 3. Swiss Cardiovascular Center, University Hospital Bern, Bern, Switzerland. 4. Department of General Internal Medicine, Bern University Hospital, University of Bern, Bern, Switzerland. 5. Department of Internal Medicine, Cantonal Hospital Fribourg, Fribourg, Switzerland. 6. Department of Internal Medicine, Cantonal Hospital Baden, Baden, Switzerland. 7. Centre for Vascular Diseases, Zurich-Stadelhofen and Clinical for Angiology, University Hospital Zurich and University of Zurich, Zurich, Switzerland. 8. Department of Internal Medicine, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland. 9. Department of Internal Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland. 10. Division of Hematology and Central Hematology Laboratory, Luzerner Kantonsspital Luzern and University of Bern, Luzern, Switzerland. 11. Division of General Internal Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
Abstract
BACKGROUND: Improved thromboprophylaxis for acutely ill medical patients relies on valid predictions of thrombotic risks. Our aim was to compare the performance of the Improve and Geneva clinical risk assessment models (RAMs), and to simplify the current Geneva RAM. METHODS: Medical inpatients from eight Swiss hospitals were prospectively followed during 90 days, for symptomatic venous thromboembolism (VTE) or VTE-related death. We compared discriminative performance and calibration of the RAMs, using time-to-event methods with competing risk modelling of non-VTE death. RESULTS: In 1,478 patients, the 90-day VTE cumulative incidence was 1.6%. Discrimination of the Improve and Geneva RAM was similar, with a 30-day AUC (areas under the curve) of 0.78 (95% CI [confidence interval]: 0.65-0.92) and 0.81 (0.73-0.89), respectively. According to the Improve RAM, 68% of participants were at low risk (0.8% VTE at 90 days), and 32% were at high risk (4.7% VTE), with a sensitivity of 73%. According to the Geneva RAM, 35% were at low risk (0.6% VTE) and 65% were at high risk (2.8% VTE), with a sensitivity of 90%. Among patients without thromboprophylaxis, the sensitivity was numerically greater in the Geneva RAM (85%) than in the Improve RAM (54%). We derived a simplified Geneva RAM with comparable discrimination and calibration as the original Geneva RAM. CONCLUSIONS: We found comparably good discrimination of the Improve and Geneva RAMs. The Improve RAM classified more patients as low risk, but with possibly lower sensitivity and greater VTE risks, suggesting that a lower threshold for low risk (<2) should be used. The simplified Geneva RAM may represent an alternative to the Geneva RAM with enhanced usability. Schattauer GmbH Stuttgart.
BACKGROUND: Improved thromboprophylaxis for acutely ill medical patients relies on valid predictions of thrombotic risks. Our aim was to compare the performance of the Improve and Geneva clinical risk assessment models (RAMs), and to simplify the current Geneva RAM. METHODS: Medical inpatients from eight Swiss hospitals were prospectively followed during 90 days, for symptomatic venous thromboembolism (VTE) or VTE-related death. We compared discriminative performance and calibration of the RAMs, using time-to-event methods with competing risk modelling of non-VTE death. RESULTS: In 1,478 patients, the 90-day VTE cumulative incidence was 1.6%. Discrimination of the Improve and Geneva RAM was similar, with a 30-day AUC (areas under the curve) of 0.78 (95% CI [confidence interval]: 0.65-0.92) and 0.81 (0.73-0.89), respectively. According to the Improve RAM, 68% of participants were at low risk (0.8% VTE at 90 days), and 32% were at high risk (4.7% VTE), with a sensitivity of 73%. According to the Geneva RAM, 35% were at low risk (0.6% VTE) and 65% were at high risk (2.8% VTE), with a sensitivity of 90%. Among patients without thromboprophylaxis, the sensitivity was numerically greater in the Geneva RAM (85%) than in the Improve RAM (54%). We derived a simplified Geneva RAM with comparable discrimination and calibration as the original Geneva RAM. CONCLUSIONS: We found comparably good discrimination of the Improve and Geneva RAMs. The Improve RAM classified more patients as low risk, but with possibly lower sensitivity and greater VTE risks, suggesting that a lower threshold for low risk (<2) should be used. The simplified Geneva RAM may represent an alternative to the Geneva RAM with enhanced usability. Schattauer GmbH Stuttgart.
Authors: Andrea J Darzi; Allen B Repp; Frederick A Spencer; Rami Z Morsi; Rana Charide; Itziar Etxeandia-Ikobaltzeta; Kenneth A Bauer; Allison E Burnett; Mary Cushman; Francesco Dentali; Susan R Kahn; Suely M Rezende; Neil A Zakai; Arnav Agarwal; Samer G Karam; Tamara Lotfi; Wojtek Wiercioch; Reem Waziry; Alfonso Iorio; Elie A Akl; Holger J Schünemann Journal: Blood Adv Date: 2020-10-13
Authors: Walter Ageno; Renato D Lopes; Megan K Yee; Adrian Hernandez; Russell Hull; Samuel Z Goldhaber; C Michael Gibson; Alexander T Cohen Journal: J Thromb Thrombolysis Date: 2020-02 Impact factor: 2.300