Thomas Moumneh1,2, Jérémie Riou3, Delphine Douillet1, Samir Henni4, Dominique Mottier5, Tobias Tritschler2,6, Grégoire Le Gal2, Pierre-Marie Roy1. 1. Département de Médecine d'Urgence, CHU d'Angers, Institut MITOVASC, UMR CNRS 6015, UMR INSERM 1083, InnoVTE F-CRIN, Université d'Angers, Angers, France. 2. Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada. 3. Unité de Formation-Recherche Santé, MINT UMR INSERM 1066, CNRS 6021, Université d'Angers, Angers, France. 4. Service des explorations fonctionnelles vasculaires, CHU d'Angers, Institut MITOVASC, UMR CNRS 6015, UMR INSERM 1083, Université d'Angers, Angers, France. 5. Département de Médecine Interne et Pneumologie, CHU de la Cavale Blanche, EA3878 (GETBO), CIC INSERM 1412, InnoVTE F-CRIN, Université de Bretagne Occidentale, Brest, France. 6. Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Abstract
BACKGROUND: Because hospital-acquired venous thromboembolism (VTE) represents a frequent cause of preventable deaths in medical inpatients, identifying at-risk patients requiring thromboprophylaxis is critical. We aimed to externally assess the Caprini, IMPROVE, and Padua VTE risk scores and to compare their performance to advanced age as a stand-alone predictor. METHODS: We performed a retrospective analysis of patients prospectively enrolled in the PREVENU trial. Patients aged 40 years and older, hospitalized for at least 2 days on a medical ward were consecutively enrolled and followed for 3 months. Critical ill patients were not recruited. Patients diagnosed with VTE within 48 hours from admission, or receiving full dose anticoagulant treatment or who underwent surgery were excluded. All suspected VTE and deaths occurring during the 3-month follow-up were adjudicated by an independent committee. The three scores were retrospectively assessed. Body mass index, needed for the Padua and Caprini scores, was missing in 44% of patients. RESULTS: Among 14 910 eligible patients, 14 660 were evaluable, of which 1.8% experienced symptomatic VTE or sudden unexplained death during the 3-month follow-up. The area under the receiver operating characteristic curves (AUC) were 0.60 (95% confidence interval [CI] 0.57-0.63), 0.63 (95% CI 0.60-0.66) and 0.64 (95% CI 0.61-0.67) for Caprini, IMPROVE, and Padua scores, respectively. None of these scores performed significantly better than advanced age as a single predictor (AUC 0.61, 95% CI 0.58-0.64). CONCLUSION: In our study, Caprini, IMPROVE, and Padua VTE risk scores have poor discriminative ability to identify not critically ill medical inpatients at risk of VTE, and do not perform better than a risk evaluation based on patient's age alone.
BACKGROUND: Because hospital-acquired venous thromboembolism (VTE) represents a frequent cause of preventable deaths in medical inpatients, identifying at-risk patients requiring thromboprophylaxis is critical. We aimed to externally assess the Caprini, IMPROVE, and Padua VTE risk scores and to compare their performance to advanced age as a stand-alone predictor. METHODS: We performed a retrospective analysis of patients prospectively enrolled in the PREVENU trial. Patients aged 40 years and older, hospitalized for at least 2 days on a medical ward were consecutively enrolled and followed for 3 months. Critical illpatients were not recruited. Patients diagnosed with VTE within 48 hours from admission, or receiving full dose anticoagulant treatment or who underwent surgery were excluded. All suspected VTE and deaths occurring during the 3-month follow-up were adjudicated by an independent committee. The three scores were retrospectively assessed. Body mass index, needed for the Padua and Caprini scores, was missing in 44% of patients. RESULTS: Among 14 910 eligible patients, 14 660 were evaluable, of which 1.8% experienced symptomatic VTE or sudden unexplained death during the 3-month follow-up. The area under the receiver operating characteristic curves (AUC) were 0.60 (95% confidence interval [CI] 0.57-0.63), 0.63 (95% CI 0.60-0.66) and 0.64 (95% CI 0.61-0.67) for Caprini, IMPROVE, and Padua scores, respectively. None of these scores performed significantly better than advanced age as a single predictor (AUC 0.61, 95% CI 0.58-0.64). CONCLUSION: In our study, Caprini, IMPROVE, and Padua VTE risk scores have poor discriminative ability to identify not critically ill medical inpatients at risk of VTE, and do not perform better than a risk evaluation based on patient's age alone.
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: Lisa K Moores; Tobias Tritschler; Shari Brosnahan; Marc Carrier; Jacob F Collen; Kevin Doerschug; Aaron B Holley; David Jimenez; Gregoire Le Gal; Parth Rali; Philip Wells Journal: Chest Date: 2020-06-02 Impact factor: 9.410