학술논문
A prognostic score to identify low-risk outpatients with acute deep vein thrombosis in the upper extremity
Document Type
Academic Journal
Author
Rosa-Salazar, V.; Trujillo-Santos, J.; Díaz Peromingo, J. A.; Apollonio, A.; Sanz, O.; Malý, R.; Muñoz-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.; Barrón, M.; Barrón-Andrés, B.; Bascuñana, J.; Benítez, J. F.; Blanco-Molina, A.; Bueso, T.; Cañas, A.; Casado, A.; Castejón-Pina, N.; Chaves, E. L.; del Molino, F; del Toro, J; Falgá, C.; Fernández-Capitán, C.; Font, L.; Gallego, P.; García-Bragado, F.; García-Ortega, A.; Gómez, V.; González, J.; González-Marcano, D.; Grau, E.; Guijarro, R.; Guil, M.; Guirado, L.; Gutiérrez-Guisado, J.; Hernández-Blasco, L.; Jara-Palomares, L.; Jaras, M. J.; Jiménez, D.; Jiménez, R.; Lacruz, B.; Lecumberri, R.; Lobo, J. L.; López-Jiménez, L.; López-Montes, L.; López-Reyes, R.; López-Sáez, J. B.; Lorente, M. A.; Lorenzo, A.; Madridano, O.; Maestre, A.; Marchena, P. J.; Martín-Antorán, J. M.; Martín-Martos, F.; Morales, M. V.; Nauffal, D.; Nieto, J. A.; Núñez, M. J.; Otalora, S.; Otero, R.; Pagán, B.; Pedrajas, J. M.; Peris, M. L.; Pons, I.; Porras, J. A.; Riera-Mestre, A.; Rivas, A.; Rodríguez-Dávila, M. A.; Ruiz-Giménez, N.; Sabio, P.; Sampériz, A.; Sánchez, R.; Soto, M. J.; Suriñach, J. M.; Tiberio, G.; Tirado, R.; Tolosa, C.; Uresandi, F.; Valero, B.; Valle, R.; Vela, J.; Villalobos, A.; Villalta, J.; Malfante, P.; Verhamme, P.; Vanassche, T.; Tomko, T.; Hirmerova, J.; Bura-Riviere, A.; Farge-Bancel, D.; Hij, A.; Mahe, I.; Merah, A.; Moustafa, F.; Quere, I.; Babalis, D.; Tzinieris, I.; Braester, A.; Barillari, G.; Bucherini, E.; Campodomico, J.; Ciammaichella, M.; Ferrazzi, P.; Maida, R.; Pace, F.; Pasca, S.; Pesavento, R.; Piovella, C.; Rota, L.; Tiraferri, E.; Tufano, A.; Visonà, A.; Skride, A.; Belovs, A.; Moreira, M.; Ribeiro, J. L.; Sousa, M. S.; Alatri, A.; Calanca, L.; Mazzolai, L.
Source
Journal of Thrombosis and Haemostasis. Jul 01, 2015 13(7):1274-1278
Subject
Language
English
ISSN
1538-7933
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, 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. 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.