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A Prognostic Score to Identify Low-risk Outpatients with Acute Deep Vein Thrombosis in the Lower Limbs

2014; Elsevier BV; Volume: 128; Issue: 1 Linguagem: Inglês

10.1016/j.amjmed.2014.08.023

1555-7162

Javier Trujillo‐Santos, Francisco S. Lozano, M.A. Lorente, Dolores Adarraga, Jana Hirmerová, J. del Toro, Lucia Mazzolai, Giovanni Barillari, Manuel Barrón, Manuel Monréal, M.D. Adarraga, M. Alcalde, V. Andújar, J.I. Arcelus, Raquel Barba, Manuel Barrón, B. Barrón‐Andrés, J. Bascuñana, Á. Blanco-Molina, Tulio Bueso, I. Casado, A. Climent, Francisco Conget, Fátima del Molino, J. del Toro, C. Falgá, Carmen Fernández‐Capitán, Llorenç Font, P. Gallego, F. García‐Bragado, Vicente Gómez del Olmo, J. González, E. González-Bachs, E Grau, Ricardo Guijarro, María J. Guil, Javier Gutiérrez, Luis Jara‐Palomares, M.J. Jaras, David Jiménez, Ricardo Jimenez, Ramón Lecumberri, J.L. Lobo, Luciano López‐Jiménez, L. López‐Montes, Raquel López-Reyes, J.B. López‐Sáez, M.A. Lorente, A. García de Lorenzo, José Manuel Luque, Olga Madridano, Pablo Javier Marchena, J.M. Martín‐Antorán, Meritxell Mellado, Manuel Monréal, M.V. Morales, D. Nauffal, José Antonio Nieto, Manuel Jesús Núñez, J.L. Ogea, Remedios Otero, B. Pagán, José María Pedrajas, Gloria Pérez‐Rus, M.L. Peris, José Antonio Porras, I. Pons, Antoni Riera‐Mestre, A. Rivas, M.A. Rodríguez‐Dávila, P. Román, V. Rosa, N. Ruiz‐Giménez, José M. Oliver, P. Sabio, A. Sampériz, Rosario Sánchez‐Martínez, S. Soler, José María Suriñach, G. Tiberio, Javier Trujillo‐Santos, Fernando Uresandi, B. Valero, R. Valle, J. Vela, A. Villalobos, Pablo Malfante, Peter Verhamme, Kathelijne Peerlinck, Philip Wells, Radován Malý, Jana Hirmerová, Markéta Kaletová, T. Tomko, Laurent Bertoletti, A. Bura-Rivière, Maan Fares, C. Grangé, I. Mahé, A. Merah, I. Quéré, Sebastian Schellong, Marios Papadakis, Andrei Braester, Benjamin Brenner, Inna Tzoran, David Zeltser, A. Apollonio, Giovanni Barillari, Maurizio Ciammaichella, P. Di Micco, R. Duce, Anna Guida, R. Maida, F. Pace, Samantha Pasca, Chiara Piovella, Raffaele Pesavento, Renzo Poggio, P. Prandoni, L. Rota, Eros Tiraferri, D. Tonello, Antonella Tufano, A. Visonà, Beniamino Zalunardo, Sofia Almeida, F. Leal-Seabra, Mariana S. Sousa, Marijan Bosevski, Adriano Alatri, Henri Bounameaux, Luca Calanca, Lucia Mazzolai, Juan Carlos Serrano,

Central Venous Catheters and Hemodialysis

Background No prior studies have identified which patients with deep vein thrombosis in the lower limbs are at a low risk for adverse events within the first week of therapy. Methods We used data from the Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) to identify patients at low risk for the composite outcome of pulmonary embolism, major bleeding, or death within the first week. We built a prognostic score and compared it with the decision to treat patients at home. Results As of December 2013, 15,280 outpatients with deep vein thrombosis had been enrolled. Overall, 5164 patients (34%) were treated at home. Of these, 12 (0.23%) had pulmonary embolism, 8 (0.15%) bled, and 4 (0.08%) died. On multivariable analysis, chronic heart failure, recent immobility, recent bleeding, cancer, renal insufficiency, and abnormal platelet count independently predicted the risk for the composite outcome. Among 11,430 patients (75%) considered to be at low risk, 15 (0.13%) suffered pulmonary embolism, 22 (0.19%) bled, and 8 (0.07%) died. The C-statistic was 0.61 (95% confidence interval [CI], 0.57-0.65) for the decision to treat patients at home and 0.76 (95% CI, 0.72-0.79) for the score (P = .003). Net reclassification improvement was 41% (P < .001). Integrated discrimination improvement was 0.034 for the score and 0.015 for the clinical decision (P < .001). Conclusions Using 6 easily available variables, we identified outpatients with deep vein thrombosis at low risk for adverse events within the first week. These data may help to safely treat more patients at home. This score, however, should be validated.