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Thromb Haemost. 2017 Jul 26;117(8):1630-1636. doi: 10.1160/TH17-02-0116. Epub 2017 May 18.

Low discriminating power of the modified Ottawa VTE risk score in a cohort of patients with cancer from the RIETE registry.

Author information

1
Dr. Adriano Alatri, Division of Angiology, Lausanne University Hospital (CHUV), Chemin du Mont-Paisible 18, 1011 Lausanne Switzerland, Tel.: +41 21 3146014, Fax: +41 21 3140761, E-mail: Adriano.Alatri@chuv.ch.

Abstract

Treatment of patients with cancer-associated venous thromboembolism (VTE) remains a major challenge. The modified Ottawa score is a clinical prediction rule evaluating the risk of VTE recurrences during the first six months of anticoagulant treatment in patients with cancer-related VTE. We aimed to validate the Ottawa score using data from the RIETE registry. A total of 11,123 cancer patients with VTE were included in the analysis. According to modified Ottawa score, 2,343 (21 %) were categorised at low risk for VTE recurrences, 4,525 (41 %) at intermediate risk, and 4,255 (38 %) at high risk. Overall, 477 episodes of VTE recurrences were recorded during the course of anticoagulant therapy, with an incidence rate for low, intermediate, and high risk groups of 6.88 % (95 % CI 5.31-8.77), 11.8 % (95 % CI 10.1-13.6), and 21.3 % (95 % CI 18.8-24.1) patient-years, respectively. Overall mortality had an incidence rate of 21.1 % (95 % CI 18.2-24.3), 79.4 % (95 % CI: 74.9-84.1), and 134.7 % (95 % CI: 128.3-141.4) patient-years, respectively. The accuracy and discriminating power of the modified Ottawa score for VTE recurrence was modest, with low sensitivity, specificity and positive predictive value, and a C-statistics of 0.58 (95 % CI: 0.56-0.61). In our analysis, the modified Ottawa score did not accurately predict VTE recurrence among patients with cancer-associated thrombosis, thus hindering its use in clinical practice. It is time to define a new score including other clinical predictors.

KEYWORDS:

Venous thromboembolism; decision support techniques; neoplasms; recurrence; venous thrombosis

PMID:
28517021
DOI:
10.1160/TH17-02-0116
[Indexed for MEDLINE]

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