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Am J Med. 2015 Jan;128(1):90.e9-15. doi: 10.1016/j.amjmed.2014.08.023. Epub 2014 Sep 19.

A prognostic score to identify low-risk outpatients with acute deep vein thrombosis in the lower limbs.

Collaborators (125)

Adarraga MD, Alcalde M, Andújar V, Arcelus JI, Barba R, Barrón M, Barrón-Andrés B, Bascuñana J, Blanco-Molina A, Bueso T, Casado I, Climent A, Conget F, del Molino F, del Toro J, Falgá C, Fernández-Capitán C, Font L, Gallego P, García-Bragado F, Gómez V, González J, González-Bachs E, Grau E, Guijarro R, Guil M, Gutiérrez J, Jara-Palomares L, Jaras MJ, Jiménez D, Jiménez R, Lecumberri R, Lobo JL, López-Jiménez L, López-Montes L, López-Reyes R, López-Sáez JB, Lorente MA, Lorenzo A, Luque JM, Madridano O, Marchena PJ, Martín-Antorán JM, Mellado M, Monreal M, Morales MV, Nauffal D, Nieto JA, Núñez MJ, Ogea JL, Otero R, Pagán B, Pedrajas JM, Pérez-Rus G, Peris ML, Porras JA, Pons I, Riera-Mestre A, Rivas A, Rodríguez-Dávila MA, Román P, Rosa V, Ruiz-Giménez N, Ruiz J, Sabio P, Samperiz A, Sánchez R, Soler S, Suriñach JM, Tiberio G, Trujillo-Santos J, Uresandi F, Valero B, Valle R, Vela J, Villalobos A, Malfante P, Verhamme P, Peerlinck K, Wells P, Malý R, Hirmerova J, Kaletova M, Tomko T, Bertoletti L, Bura-Riviere A, Farès M, Grange C, Mahe I, Merah A, Quere I, Schellong S, Papadakis M, Braester A, Brenner B, Tzoran I, Zeltser D, Apollonio A, Barillari G, Ciammaichella M, Di Micco P, Duce R, Guida A, Maida R, Pace F, Pasca S, Piovella C, Pesavento R, Poggio R, Prandoni P, Rota L, Tiraferri E, Tonello D, Tufano A, Visonà A, Zalunardo B, Almeida S, Leal-Seabra F, Sousa MS, Bosevski M, Alatri A, Bounameaux H, Calanca L, Mazzolai L, Serrano JC.

Author information

1
Department of Internal Medicine, Complejo Hospitalario Universitario de Cartagena, Murcia, Spain.
2
Department of Angiology and Vascular Surgery, Complejo Asistencial de Salamanca, Salamanca, Spain.
3
Department of Internal Medicine, Hospital de la Agencia Valenciana de Salud Vega Baja, Alicante, Spain.
4
Department of Internal Medicine, Hospital de Montilla, Córdoba, Spain.
5
Department of Internal Medicine, University Hospital Plzen, Plzen, Czech Republic.
6
Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
7
Department of Angiology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
8
Department of Internal Medicine, Ospedale S. Maria della Misericordia, Udine, Italy.
9
Department of Pneumonology, Hospital San Pedro, Logroño, La Rioja, Spain.
10
Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain. Electronic address: mmonreal.germanstrias@gencat.cat.

Abstract

BACKGROUND:

No prior studies have identified which patients with deep vein thrombosis in the lower limbs are at a low risk for adverse events within the first week of therapy.

METHODS:

We used data from the Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) to identify patients at low risk for the composite outcome of pulmonary embolism, major bleeding, or death within the first week. We built a prognostic score and compared it with the decision to treat patients at home.

RESULTS:

As of December 2013, 15,280 outpatients with deep vein thrombosis had been enrolled. Overall, 5164 patients (34%) were treated at home. Of these, 12 (0.23%) had pulmonary embolism, 8 (0.15%) bled, and 4 (0.08%) died. On multivariable analysis, chronic heart failure, recent immobility, recent bleeding, cancer, renal insufficiency, and abnormal platelet count independently predicted the risk for the composite outcome. Among 11,430 patients (75%) considered to be at low risk, 15 (0.13%) suffered pulmonary embolism, 22 (0.19%) bled, and 8 (0.07%) died. The C-statistic was 0.61 (95% confidence interval [CI], 0.57-0.65) for the decision to treat patients at home and 0.76 (95% CI, 0.72-0.79) for the score (P = .003). Net reclassification improvement was 41% (P < .001). Integrated discrimination improvement was 0.034 for the score and 0.015 for the clinical decision (P < .001).

CONCLUSIONS:

Using 6 easily available variables, we identified outpatients with deep vein thrombosis at low risk for adverse events within the first week. These data may help to safely treat more patients at home. This score, however, should be validated.

KEYWORDS:

Anticoagulant therapy; Deep venous thrombosis; Home; Hospital; Outcome

PMID:
25242230
DOI:
10.1016/j.amjmed.2014.08.023
[Indexed for MEDLINE]

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