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

2015; Elsevier BV; Volume: 13; Issue: 7 Linguagem: Inglês

10.1111/jth.13008

1538-7933

Vladimir Rosa‐Salazar, Javier Trujillo-Santos, José Antonio Díaz Peromingo, A. Apollonio, O. Sanz, Radován Malý, Francisco J. Muñoz, Juan Carlos Serrano, S. Soler, Manuel Monréal, Hervé Decousus, P. Prandoni, Benjamin Brenner, Raquel Barba, P. Di Micco, Laurent Bertoletti, Sebastian Schellong, Inna Tzoran, Abílio Reis, Marijan Bosevski, H Bounameaux, Philip Wells, Marios Papadakis, M.D. Adarraga, A. Alibalic, A. Alvarado‐Faria, J.I. Arcelus, Teresa Auguet, Aitor Ballaz, M. Barrón, B. Barrón‐Andrés, J. Bascuñana, Juan Benitez, Á. Blanco-Molina, Tulio Bueso, Alejandra Cañas, Antonio Casado, N. Castejón‐Pina, E.L. Chaves, Francesca Molino, J. del Toro, C. Falgá, Carmen Fernández‐Capitán, Llorenç Font, P. Gallego, F. García‐Bragado, Alberto García‐Ortega, Vicente Gómez del Olmo, J. González, D. González‐Marcano, E Grau, Ricardo Guijarro, María J. Guil, L. Guirado, Javier Gutiérrez-Guisado, Luis Blasco, Luis Jara‐Palomares, M.J. Jaras, David Jiménez, Ricardo Jimenez, B. Lacruz, Ramón Lecumberri, José Luís Lobo, Luciano López‐Jiménez, L. López‐Montes, Raquel López-Reyes, J.B. López‐Sáez, M.A. Lorente, A. García de Lorenzo, Olga Madridano, Ana M. Maestre, Pablo Javier Marchena, J.M. Martín‐Antorán, F. Martín‐Martos, M.V. Morales, D. Nauffal, José Antonio Nieto, Manuel Jesús Núñez, S. Otálora, Remedios Otero, B. Pagán, José María Pedrajas, M.L. Peris, I. Pons, José Antonio Porras, Antoni Riera‐Mestre, A. Rivas, M.A. Rodríguez‐Dávila, N. Ruiz‐Giménez, P. Sabio, A. Sampériz, Rosario Sánchez‐Martínez, M.J. Soto, José María Suriñach, G. Tiberio, Raimundo Tirado, Carlos Tolosa, Fernando Uresandi, B. Valero, R. Valle, J. Vela, A. Villalobos, J Villalta, Pablo Malfante, Peter Verhamme, Thomas Vanassche, T. Tomko, Jana Hirmerová, A. Bura-Rivière, Dominique Farge, A. Hij, I. Mahé, A. Merah, F. Moustafa, I. Quéré, Dimitrios Babalis, I. Tzinieris, Andrei Braester, Giovanni Barillari, Eugenio Bucherini, J. Campodomico, Maurizio Ciammaichella, Paola Ferrazzi, R. Maida, F. Pace, Samantha Pasca, Raffaele Pesavento, Chiara Piovella, L. Rota, Eros Tiraferri, Antonella Tufano, A. Visonà, Andris Skride, A. Belovs, Margarida Cardoso-Moreira, Jerri Luiz Ribeiro, Mariana S. Sousa, Adriano Alatri, Luca Calanca, Lucia Mazzolai,

Diagnosis and Treatment of Venous Diseases

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.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.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.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.