Background: No studies have identified which patients with upper-extremity deep vein thrombosis (DVT) are at low risk for adverse events within the first week of therapy. Methods: We used data from Registro Informatizado de la Enfermedad TromboEmbólica to explore in patients with upper-extremity DVT a prognostic score that correctly identified patients with lower limb DVT at low risk for pulmonary embolism, major bleeding, or death within the first week. Results: As of December 2014, 1135 outpatients with upper-extremity DVT were recruited. Of these, 515 (45%) were treated at home. During the first week, three patients (0.26%) experienced pulmonary embolism, two (0.18%) had major bleeding, and four (0.35%) died. We assigned 1 point to patients with chronic heart failure, creatinine clearance levels 30-60 mL min -1 , recent bleeding, abnormal platelet count, recent immobility, or cancer without metastases; 2 points to those with metastatic cancer; and 3 points to those with creatinine clearance levels < 30 mL min -1 . Overall, 759 (67%) patients scored ≤ 1 point and were considered to be at low risk. The rate of the composite outcome within the first week was 0.26% (95% confidence interval [CI] 0.004-0.87) in patients at low risk and 1.86% (95% CI 0.81-3.68) in the remaining patients. C-statistics was 0.73 (95% CI 0.57-0.88). Net reclassification improvement was 22%, and integrated discrimination improvement was 0.0055. Conclusions: Using six easily available variables, we identified outpatients with upper-extremity DVT at low risk for adverse events within the first week. These data may help to safely treat more patients at home.
A prognostic score to identify low-risk outpatients with acute deep vein thrombosis in the upper extremity / Rosa-Salazar, V.; Trujillo-Santos, J.; Diaz Peromingo, J. A.; Apollonio, A.; Sanz, O.; Maly, R.; Munoz-Rodriguez, F. J.; Serrano, J. C.; Soler, S.; Monreal, M.; Decousus, H.; Prandoni, P.; Brenner, B.; Barba, R.; Di Micco, P.; Bertoletti, L.; Schellong, S.; Tzoran, I.; Reis, A.; Bosevski, M.; Bounameaux, H.; Wells, P.; Papadakis, M.; Adarraga, M. D.; Alibalic, A.; Alvarado-Faria, A.; Arcelus, J. I.; Auguet, T.; Ballaz, A.; Barron, M.; Barron-Andres, B.; Bascunana, J.; Benitez, J. F.; Blanco-Molina, A.; Bueso, T.; Canas, A.; Casado, A.; Castejon-Pina, N.; Chaves, E. L.; del Molino, F.; del Toro, J.; Diaz, J. A.; Falga, C.; Fernandez-Capitan, C.; Font, L.; Gallego, P.; Garcia-Bragado, F.; Garcia-Ortega, A.; Gomez, V.; Gonzalez, J.; Gonzalez-Marcano, D.; Grau, E.; Guijarro, R.; Guil, M.; Guirado, L.; Gutierrez-Guisado, J.; Hernandez-Blasco, L.; Jara-Palomares, L.; Jaras, M. J.; Jimenez, D.; Jimenez, R.; Lacruz, B.; Lecumberri, R.; Lobo, J. L.; Lopez-Jimenez, L.; Lopez-Montes, L.; Lopez-Reyes, R.; Lopez-Saez, J. B.; Lorente, M. A.; Lorenzo, A.; Madridano, O.; Maestre, A.; Marchena, P. J.; Martin-Antoran, J. M.; Martin-Martos, F.; Montreal, M.; Morales, M. V.; Nauffal, D.; Nieto, J. A.; Nunez, M. J.; Otalora, S.; Otero, R.; Pagan, B.; Pedrajas, J. M.; Peris, M. L.; Pons, I.; Porras, J. A.; Riera-Mestre, A.; Rivas, A.; Rodriguez-Davila, M. A.; Ruiz-Gimenez, N.; Sabio, P.; Samperiz, A.; Sanchez, R.; Soto, M. J.; Surinach, J. M.; Tiberio, G.; Tirado, R.; Tolosa, C.; Uresandi, F.; Valero, B.; Valle, R.; Vela, J.; Villalobos, A.; Verhamme, P.; Tomko, T.; Villalta, J.; Malfante, P.; Mahe, I.; Vanassche, T.; Moustafa, F.; Babalis, D.; Hirmerova, J.; Barillari, G.; Bucherini, E.; Farge-Bance, D.; Ciammaichella, M.; Ferrazzi, P.; Maida, R.; Pace, F.; Quere, I.; Pesavento, R.; Piovella, C.; Rota, L.; Tzinieris, I.; Tufano, A.; Skride, A.; Moreira, M.; Ribeiro, J. L.; Alatri, A.; Calanca, L.; Visona, A.; Belovs, A.; Sousa, M. S.. - In: JOURNAL OF THROMBOSIS AND HAEMOSTASIS. - ISSN 1538-7933. - 13:7(2015), pp. 1274-1278. [10.1111/jth.13008]
A prognostic score to identify low-risk outpatients with acute deep vein thrombosis in the upper extremity
Di Micco P.;Gonzalez J.;Valle R.;Tufano A.;
2015
Abstract
Background: No studies have identified which patients with upper-extremity deep vein thrombosis (DVT) are at low risk for adverse events within the first week of therapy. Methods: We used data from Registro Informatizado de la Enfermedad TromboEmbólica to explore in patients with upper-extremity DVT a prognostic score that correctly identified patients with lower limb DVT at low risk for pulmonary embolism, major bleeding, or death within the first week. Results: As of December 2014, 1135 outpatients with upper-extremity DVT were recruited. Of these, 515 (45%) were treated at home. During the first week, three patients (0.26%) experienced pulmonary embolism, two (0.18%) had major bleeding, and four (0.35%) died. We assigned 1 point to patients with chronic heart failure, creatinine clearance levels 30-60 mL min -1 , recent bleeding, abnormal platelet count, recent immobility, or cancer without metastases; 2 points to those with metastatic cancer; and 3 points to those with creatinine clearance levels < 30 mL min -1 . Overall, 759 (67%) patients scored ≤ 1 point and were considered to be at low risk. The rate of the composite outcome within the first week was 0.26% (95% confidence interval [CI] 0.004-0.87) in patients at low risk and 1.86% (95% CI 0.81-3.68) in the remaining patients. C-statistics was 0.73 (95% CI 0.57-0.88). Net reclassification improvement was 22%, and integrated discrimination improvement was 0.0055. Conclusions: Using six easily available variables, we identified outpatients with upper-extremity DVT at low risk for adverse events within the first week. These data may help to safely treat more patients at home.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
