A risk score for prediction of recurrence in patients with unprovoked venous thromboembolism (DAMOVES)

Moreno, Ana Isabel Franco; Navarro, María José García; Sánchez, J. Ortiz; Díaz, Raquel; Cerezo, Elena Madroñal; Aracil, Cristina Lucía De Ancos; Clotet, N. Cabello; Fraile, Isabel Perales; García, Sobrino; Hernandez, Christie; Gaviria, A. Zapatero; Giardín, José Manuel Ruiz

doi:10.1016/j.ejim.2015.12.010

Cited by 46 publications

(31 citation statements)

References 46 publications

(52 reference statements)

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“…Three prognostic models for individual VTE recurrence risk after discontinuation of anticoagulation after one idiopathic VTE-HERDOO2 score, "Vienna prediction model" and DASH score-do not take thrombophilia into account [78]. In the score of Franco Moreno et al [79] the genetic thrombophilia is statistically significant, but only as a retrospective observation, no prospective validation was performed with this score. If evidence of hereditary thrombophilia is present with possible consequences for offsprings, especially women of childbearing age, a family status (targeted partial thrombophilia evaluation) is recommended.…”

Section: Regarding Therapy Of Thrombosismentioning

confidence: 99%

Thrombophilia screening revisited: an issue of personalized medicine

Colucci

Tsakiris

2020

J Thromb Thrombolysis

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Clinical thrombophilia is the consequence of multiple gene and/or environment interactions. Thrombophilia screening requires a targeted patient with specific indication, in which a finding would have implications. Carrying out a thrombophilia examination in the physician's practice is often a cause of uncertainty and concern. The concerns begin in choosing the right patient to be examined, are associated with the time of investigation, with the choice of analysis, the test-material and with the correct interpretation of the results. Difficulties, which can influence the results, can occur with both organization and blood sampling. As common for any analysis, pre-analytical, analytical and post-analytical factors should be considered, as well as the possibility of false positive or false negative results. Finally, recommendation of correct therapeutic and prophylactic measures for the patient and his relatives is an additional focus. In this article we want to provide-on the basis of the evidence and personal experience-the theory of thrombophilia-investigation, the indications for testing, as well as practical recommendations for treatment options. Keywords Venous thromboembolism • Thrombophilia screening • Genetic thrombophilia Highlights • Thrombophilia screening should be a global, comprehensive, personalized evaluation of the patient's prothrombotic state. • Global thrombophilia evaluation is indicated in all patients with thromboembolism, whereas thrombophiliaspecific laboratory screening only in selected cases. • Thrombophilia investigation should not be performed just for defining the duration of anticoagulation, but it helps in estimating the individual recurrence risk for throm-botic disease, the need for thrombotic prophylaxis or for the decision to prolong anticoagulation therapy. • Genetic causes of thrombophilia are significant risk factors for a first thromboembolic event but they do not influence decisively recurrent thrombotic risk. • Although single genetic thrombophilia is mostly kept in balance in children and young adults, it can cause serious thrombotic disease in adults, as soon as acquired risk factors are additionally prevalent (gene-environment interaction) or if multiple deviations in thrombophilia genes co-exist (gene-gene interaction). Dedicato a mio padre Vincenzo, esempio perenne di onestà e bontà umana (06.02.1944-22.03.2020).

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Section: Regarding Therapy Of Thrombosismentioning

confidence: 99%

Thrombophilia screening revisited: an issue of personalized medicine

Colucci

Tsakiris

2020

J Thromb Thrombolysis

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“…The method yields subhazard ratios (SHR) with corresponding 95% confidence intervals (CIs). We adjusted the models for risk factors previously shown to be associated with recurrent VTE (age, sex, active cancer, history of VTE) [28][29][30][31][32], as well as periods of anticoagulation as a time-varying covariate. For overall mortality, we used Cox-regression with robust standard errors, adjusting for age, sex, active cancer, chronic lung disease, heart failure [18,33,34], and periods of anticoagulation as a timevarying covariate.…”

Section: Statistical Analysesmentioning

confidence: 99%

Clinical presentation and outcomes in elderly patients with symptomatic isolated subsegmental pulmonary embolism

Stoller

Limacher

Méan

et al. 2019

Thrombosis Research

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“…We found a wide variation in choice of determinants, which likely reflects a large extent of between-practice variation as well as individual physician's preferences. Surprisingly, determinants included in existing risk scores for recurrent VTE were infrequently mentioned as reasons for extended treatment (age > 65 years, proximal DVT, obesity, body mass index, post-thrombotic syndrome and elevated D-dimer levels during follow-up) [13][14][15]20]. In addition, several frequently mentioned determinants for extended treatment are not supported by evidence nor guidelines, including hemodynamic instability during previous PE, known thrombophilia, immobilization, incomplete resolution of thrombi on ultrasound or CTPA and male sex [3][4][5].…”

Section: Abbreviations: Vte Venous Thromboembolismmentioning

confidence: 99%

Short-term versus extended anticoagulant treatment for unprovoked venous thromboembolism: A survey on guideline adherence and physicians' considerations

Winter

Remme

Kaasjager

et al. 2019

Thrombosis Research

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Background: In patients with unprovoked venous thromboembolism (VTE), anticoagulant treatment duration should be decided by weighing bleeding risk versus risk of recurrent VTE, considering patient's preference. Because both risks differ between individuals, this recommendation presumably leads to wide variation in clinical management. Objectives: To identify physician's considerations when deciding between short-term and extended anticoagulation and to assess how current guidelines are put to practice. Materials and methods: An online, 33-item survey was developed, containing questions on clinical management, considerations regarding treatment duration, risk scores, information tools and shared decision-making. It was distributed to internists, pulmonologists and residents treating patients with VTE in the Netherlands. Results: 69 internists and 73 pulmonologists including 24 residents participated in the survey. Extended treatment was preferred by 73% (104/142) of participants. Most important reasons for extended treatment were, in descending order: patient's preference, active malignancy, low estimated bleeding risk, history of VTE and hemodynamic instability during previous VTE. Most important reasons for short-term treatment were frequent falls, history of major bleeding, previous bleeding during anticoagulation, patient's preference and thrombocytopenia. Although existing risk scores are infrequently used, physicians express their need for scores combining risks of recurrence and bleeding to aid individualized decision-making. Conclusion: Our results confirm a wide variety of considerations regarding treatment duration in patients with unprovoked VTE. Although most participants followed guidelines' recommendations to prescribe indefinite treatment in absence of contraindications, rationale is not always supported by evidence. A clinical decision tool to estimate and weigh risks of recurrence and bleeding is warranted.

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A risk score for prediction of recurrence in patients with unprovoked venous thromboembolism (DAMOVES)

Cited by 46 publications

References 46 publications

Thrombophilia screening revisited: an issue of personalized medicine

Thrombophilia screening revisited: an issue of personalized medicine

Clinical presentation and outcomes in elderly patients with symptomatic isolated subsegmental pulmonary embolism

Short-term versus extended anticoagulant treatment for unprovoked venous thromboembolism: A survey on guideline adherence and physicians' considerations

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