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A prognostic score to identify low-risk outpatients with acute deep vein thrombosis in the upper extremity

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.
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https://hal.umontpellier.fr/hal-01944477
Contributeur : Anthony Herrada <>
Soumis le : mardi 4 décembre 2018 - 16:27:45
Dernière modification le : vendredi 15 mai 2020 - 12:22:07

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V. Rosa-Salazar, J. Trujillo-Santos, J.A. Díaz Peromingo, A. Apollonio, O. Sanz, et al.. A prognostic score to identify low-risk outpatients with acute deep vein thrombosis in the upper extremity. Journal of Thrombosis and Haemostasis, Wiley, 2015, 13 (7), pp.1274-1278. ⟨10.1111/jth.13008⟩. ⟨hal-01944477⟩

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