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

V. Rosa-Salazar, J. Trujillo-Santos, J. A. Díaz Peromingo, A. Apollonio, O. Sanz, R. Malý, F. J. Muñoz-Rodriguez, J. C. Serrano, S. Soler, M. Monreal (Coresponding Author), The RIETE Investigators, A. Skride (Member of the Working Group)

Research output: Contribution to journalArticlepeer-review

8 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)1274-1278
Number of pages5
JournalJournal of Thrombosis and Haemostasis
Volume13
Issue number7
DOIs
Publication statusPublished - 1 Jul 2015
Externally publishedYes

Keywords*

  • Anticoagulant therapy
  • Deep vein thrombosis
  • Hospital
  • Outcome
  • Outpatients
  • Upper extremity

Field of Science*

  • 3.2 Clinical medicine

Publication Type*

  • 1.1. Scientific article indexed in Web of Science and/or Scopus database

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