scholarly journals Validation of risk assessment models for venous thrombosis in hospitalized medical patients

2019 ◽  
Vol 3 (2) ◽  
pp. 217-225 ◽  
Author(s):  
Michelle R. R. Cobben ◽  
Banne Nemeth ◽  
Willem M. Lijfering ◽  
Suzanne C. Cannegieter
Keyword(s):  
Risk Assessment ◽  
Venous Thrombosis ◽  
Medical Patients ◽  
Risk Assessment Models

scholarly journals Risk-assessment models for VTE and bleeding in hospitalized medical patients: an overview of systematic reviews

2020 ◽  
Vol 4 (19) ◽  
pp. 4929-4944
Author(s):  
Andrea J. Darzi ◽  
Allen B. Repp ◽  
Frederick A. Spencer ◽  
Rami Z. Morsi ◽  
Rana Charide ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Systematic Reviews ◽  
Risk Of Bias ◽  
Clinical Expertise ◽  
Medical Patients ◽  
Vte Prophylaxis ◽  
Risk Assessment Models ◽  
Medical Inpatients ◽  
Overview Of Systematic Reviews

Abstract Multiple risk-assessment models (RAMs) for venous thromboembolism (VTE) in hospitalized medical patients have been developed. To inform the 2018 American Society of Hematology (ASH) guidelines on VTE, we conducted an overview of systematic reviews to identify and summarize evidence related to RAMs for VTE and bleeding in medical inpatients. We searched Epistemonikos, the Cochrane Database, Medline, and Embase from 2005 through June 2017 and then updated the search in January 2020 to identify systematic reviews that included RAMs for VTE and bleeding in medical inpatients. We conducted study selection, data abstraction and quality assessment (using the Risk of Bias in Systematic Reviews [ROBIS] tool) independently and in duplicate. We described the characteristics of the reviews and their included studies, and compared the identified RAMs using narrative synthesis. Of 15 348 citations, we included 2 systematic reviews, of which 1 had low risk of bias. The reviews included 19 unique studies reporting on 15 RAMs. Seven of the RAMs were derived using individual patient data in which risk factors were included based on their predictive ability in a regression analysis. The other 8 RAMs were empirically developed using consensus approaches, risk factors identified from a literature review, and clinical expertise. The RAMs that have been externally validated include the Caprini, Geneva, IMPROVE, Kucher, and Padua RAMs. The Padua, Geneva, and Kucher RAMs have been evaluated in impact studies that reported an increase in appropriate VTE prophylaxis rates. Our findings informed the ASH guidelines. They also aim to guide health care practitioners in their decision-making processes regarding appropriate individual prophylactic management.

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.

The use of weighted and scored risk assessment models for venous thromboembolism

2012 ◽  
Vol 108 (12) ◽  
pp. 1072-1076 ◽  
Author(s):  
Thomas McGinn ◽  
Alok Khorana ◽  
Alex Spyropoulos
Keyword(s):  
Risk Assessment ◽  
Clinical Practice ◽  
Venous Thromboembolism ◽  
Goodness Of Fit ◽  
Statistical Significance ◽  
Univariate Analysis ◽  
External Validation ◽  
Prognostic Index ◽  
Medical Patients ◽  
Risk Assessment Models

SummaryFormalised risk assessment models (RAMs) for venous thromboembolism (VTE) using weighted and scored variables have only recently been widely incorporated into international antithrombotic guidelines.Scored and weighted VTE RAMs have advantages over a simplified group-specific VTE risk approach, with the potential to allow more tailored strategies for thromboprophylaxis and an improved estimation of the risk/benefit profile for a particular patient. The derivation of VTE RAMs should be based on variables that are a priori defined or identified in a univariate analysis and the predictive capability of each variable should be rigorously assessed for both clinical and statistical significance and internal consistency and completeness. The assessment of the RAM should include the goodness of fit of the model and construction of a prognostic index score. Any VTE RAM which has been derived must undergo validation of that model before it can be used in clinical practice. Validation of the model should be performed in a “deliberate”prospective fashion across several diverse clinical sites using pre-defined criteria using basic standards for performing model validation. We discuss the basic concepts in the derivation of recent scored and weighted VTE RAMs in hospitalised surgical and medical patients and cancer outpatients, the mechanisms for accurate external validation of the models, and implications for their use in clinical practice.

External validation of a risk assessment model for venous thromboembolism in the hospitalised acutely-ill medical patient (VTE-VALOURR)

2014 ◽  
Vol 112 (10) ◽  
pp. 692-699 ◽  
Author(s):  
Charles Mahan ◽  
Yang Liu ◽  
A. Graham Turpie ◽  
Jennifer Vu ◽  
Nancy Heddle ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Validation Cohort ◽  
External Validation ◽  
Medical Patient ◽  
Risk Groups ◽  
Assessment Model ◽  
Medical Patients ◽  
Control Cohort ◽  
Derivation Cohort ◽  
Risk Assessment Models

SummaryVenous thromboembolic (VTE) risk assessment remains an important issue in hospitalised, acutely-ill medical patients, and several VTE risk assessment models (RAM) have been proposed. The purpose of this large retrospective cohort study was to externally validate the IMPROVE RAM using a large database of three acute care hospitals. We studied 41,486 hospitalisations (28,744 unique patients) with 1,240 VTE hospitalisations (1,135 unique patients) in the VTE cohort and 40,246 VTE-free hospitalisations (27,609 unique patients) in the control cohort. After chart review, 139 unique VTE patients were identified and 278 randomly-selected matched patients in the control cohort. Seven independent VTE risk factors as part of the RAM in the derivation cohort were identified. In the validation cohort, the incidence of VTE was 0.20%; 95% confidence interval (CI) 0.18–0.22, 1.04%; 95%CI 0.88–1.25, and 4.15%; 95%CI 2.79–8.12 in the low, moderate, and high VTE risk groups, respectively, which compared to rates of 0.45%, 1.3%, and 4.74% in the three risk categories of the derivation cohort. For the derivation and validation cohorts, the total percentage of patients in low, moderate and high VTE risk occurred in 68.6% vs 63.3%, 24.8% vs 31.1%, and 6.5% vs 5.5%, respectively. Overall, the area under the receiver-operator characteristics curve for the validation cohort was 0.7731. In conclusion, the IMPROVE RAM can accurately identify medical patients at low, moderate, and high VTE risk. This will tailor future thromboprophylactic strategies in this population as well as identify particularly high VTE risk patients in whom multimodal or more intensive prophylaxis may be beneficial.

scholarly journals Level of concordance between two risk-assessment models for predicting venous thromboembolism in medical patients at admission

2015 ◽  
Vol 23 (3) ◽  
pp. 141-144
Author(s):  
Ana De Lorenzo-Pinto ◽  
Raquel García-Sánchez ◽  
Esther Durán-García ◽  
Ana Castuera-Gil ◽  
Cristina Pascual-Izquierdo ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Medical Patients ◽  
Risk Assessment Models
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