Yuji Nishimoto1, Yugo Yamashita2, Takeshi Morimoto3, Syunsuke Saga1, Hidewo Amano4, Toru Takase5, Seiichi Hiramori6, Kitae Kim7, Maki Oi8, Masaharu Akao9, Yohei Kobayashi10, Mamoru Toyofuku11, Toshiaki Izumi12, Tomohisa Tada13, Po-Min Chen14, Koichiro Murata15, Yoshiaki Tsuyuki16, Tomoki Sasa17, Jiro Sakamoto18, Minako Kinoshita19, Kiyonori Togi20, Hiroshi Mabuchi21, Kensuke Takabayashi22, Yusuke Yoshikawa23, Hiroki Shiomi23, Takao Kato23, Takeru Makiyama23, Koh Ono23, Yukihito Sato1, Takeshi Kimura23. 1. Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan. 2. Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan. Electronic address: yyamashi@kuhp.kyoto-u.ac.jp. 3. Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan. 4. Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan. 5. Department of Cardiology, Kinki University Hospital, Osaka, Japan. 6. Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan. 7. Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan. 8. Department of Cardiology, Japanese Red Cross Otsu Hospital, Otsu, Japan. 9. Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan. 10. Department of Cardiovascular Center, Osaka Red Cross Hospital, Osaka, Japan. 11. Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan. 12. Cardiovascular Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan. 13. Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan. 14. Department of Cardiology, Osaka Saiseikai Noe Hospital, Osaka, Japan. 15. Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan. 16. Division of Cardiology, Shimada Municipal Hospital, Shimada, Japan. 17. Department of Cardiology, Kishiwada City Hospital, Kishiwada, Japan. 18. Department of Cardiology, Tenri Hospital, Tenri, Japan. 19. Department of Cardiology, Nishikobe Medical Center, Kobe, Japan. 20. Division of Cardiology, Nara Hospital, Kinki University Faculty of Medicine, Ikoma, Japan. 21. Department of Cardiology, Koto Memorial Hospital, Higashiomi, Japan. 22. Department of Cardiology, Hirakata Kohsai Hospital, Hirakata, Japan. 23. Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Abstract
INTRODUCTION: The external validation of the modified Ottawa score to predict the risk of recurrence in patients with cancer-associated venous thromboembolism (VTE) has not yet been firmly established. The present study aimed to evaluate the utility and limitations of the modified Ottawa score in the risk stratification of recurrent VTE in patients with cancer-associated VTE. MATERIALS AND METHODS: The COMMAND VTE Registry is a multicenter retrospective registry enrolling 3027 consecutive patients with acute symptomatic VTE among 29 Japanese centers. The present study population consisted of 614 cancer-associated VTE patients, who were divided into 3 groups; High-risk group: 202 patients (33%) with a modified Ottawa score ≥ 1, Intermediate-risk group: 269 patients (44%) with a score = 0, and Low-risk group: 143 patients (23%) with a score ≤ -1. RESULTS: Recurrent VTE occurred in 39 patients on anticoagulation therapy within 6 months. The cumulative incidence of recurrent VTE substantially increased in the higher risk categories by the modified Ottawa score (high-risk group: 13.6% [95%CI, 8.9%-20.2%], intermediate-risk group: 5.9% [95%CI, 3.5%-9.8%], and low-risk group: 3.0% [95%CI, 1.1%-7.8%], P = .02). The discriminating power of the score was modest with a C-statistic of 0.63. Each score component of the score had a different impact on recurrent events with a variable effect size. CONCLUSIONS: The risks of recurrence in patients with cancer-associated VTE substantially increased in the higher risk categories by using the modified Ottawa score, but the discriminating power of the score for recurrence was modest with a variable impact of each score component on recurrent events.
INTRODUCTION: The external validation of the modified Ottawa score to predict the risk of recurrence in patients with cancer-associated venous thromboembolism (VTE) has not yet been firmly established. The present study aimed to evaluate the utility and limitations of the modified Ottawa score in the risk stratification of recurrent VTE in patients with cancer-associated VTE. MATERIALS AND METHODS: The COMMAND VTE Registry is a multicenter retrospective registry enrolling 3027 consecutive patients with acute symptomatic VTE among 29 Japanese centers. The present study population consisted of 614 cancer-associated VTEpatients, who were divided into 3 groups; High-risk group: 202 patients (33%) with a modified Ottawa score ≥ 1, Intermediate-risk group: 269 patients (44%) with a score = 0, and Low-risk group: 143 patients (23%) with a score ≤ -1. RESULTS: Recurrent VTE occurred in 39 patients on anticoagulation therapy within 6 months. The cumulative incidence of recurrent VTE substantially increased in the higher risk categories by the modified Ottawa score (high-risk group: 13.6% [95%CI, 8.9%-20.2%], intermediate-risk group: 5.9% [95%CI, 3.5%-9.8%], and low-risk group: 3.0% [95%CI, 1.1%-7.8%], P = .02). The discriminating power of the score was modest with a C-statistic of 0.63. Each score component of the score had a different impact on recurrent events with a variable effect size. CONCLUSIONS: The risks of recurrence in patients with cancer-associated VTE substantially increased in the higher risk categories by using the modified Ottawa score, but the discriminating power of the score for recurrence was modest with a variable impact of each score component on recurrent events.
Authors: Remedios Otero; Aurora Solier-López; Verónica Sánchez-López; Julia Oto; Elena Arellano; Samira Marín; Luis Jara-Palomares; Teresa Elías; María Isabel Asencio; Isabel Blasco-Esquivias; María Rodríguez de la Borbolla; José María Sánchez-Díaz; Macarena Real-Domínguez; Emilio García-Cabrera; Francisco Javier Rodríguez-Martorell; Pilar Medina Journal: Cancers (Basel) Date: 2022-06-02 Impact factor: 6.575