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

• Published in: The American journal of medicine Vol. 128; no. 1; pp. 90.e9 - 90.e15
• Main Authors: Trujillo-Santos, Javier, MD, PhD, Lozano, Francisco, MD, PhD, Lorente, Manuel Alejandro, MD, Adarraga, Dolores, MD, PhD, Hirmerova, Jana, MD, PhD, Del Toro, Jorge, MD, Mazzolai, Lucia, MD, PhD, Barillari, Giovanni, MD, PhD, Barrón, Manuel, MD, Monreal, Manuel, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 2015; Elsevier Sequoia S.A; Elsevier [Commercial Publisher]
• Subjects: Adult; Aged; Aged, 80 and over; Ambulatory Care - standards; Ambulatory Care - statistics & numerical data; Anticoagulant therapy; Anticoagulants - therapeutic use; Deep venous thrombosis; Embolisms; Female; Home; Hospital; Human health and pathology; Humans; Internal Medicine; Life Sciences; Lower Extremity - blood supply; Male; Middle Aged; Mortality; Outcome; Outpatients - statistics & numerical data; Prognosis; Risk Assessment - methods; Thrombosis; Venous Thrombosis - complications; Venous Thrombosis - diagnosis; Venous Thrombosis - therapy; Hospital; Deep venous thrombosis; Home; Outcome; Anticoagulant therapy
• ISSN: 0002-9343; 1555-7162
• DOI: 10.1016/j.amjmed.2014.08.023

Abstract 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.