External validation of the simplified Geneva risk assessment model for hospital‐associated venous thromboembolism in the Padua cohort

Blondon, Marc; Righini, Marc; Nendaz, Mathieu; Glauser, Frédéric; Robert‐Ebadi, Helia; Prandoni, Paolo; Barbar, Sofia

doi:10.1111/jth.14688

Cited by 11 publications

(27 citation statements)

References 13 publications

(27 reference statements)

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“…The studies included in this review evaluated 24 validated unique RAMs. The most widely evaluated models were the Caprini RAM (22 studies), 21 23 29–33 35 36 38 40 42 43 45 46 48 49 59 60 63 70 71 Padua prediction score (16 studies), 24 27 28 30 31 34 37 45 48 49 63 64 66 67 70 71 IMPROVE models (8 studies), 27 28 31 37 47 49 50 57 the Geneva risk score (4 studies) 26–28 31 and the Kucher score (4 studies). 31 37 66 69 A summary of their associated characteristics and composite clinical variables is provided in online supplemental appendix S3 .…”

Section: Resultsmentioning

confidence: 99%

“…The present review is the largest and most comprehensive systematic review in this field to date. It includes 18 recent studies 26–31 33 42 48–50 60–63 66 67 70 published since the completion of the previous systematic review. 10 12 13 These studies are consistent with the previous literature in that they report modest performance of the assessed RAMs, with limitations in methodology and reporting preventing further analysis.…”

Section: Discussionmentioning

confidence: 99%

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Risk assessment models for venous thromboembolism in hospitalised adult patients: a systematic review

et al. 2021

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IntroductionHospital-acquired thrombosis accounts for a large proportion of all venous thromboembolism (VTE), with significant morbidity and mortality. This subset of VTE can be reduced through accurate risk assessment and tailored pharmacological thromboprophylaxis. This systematic review aimed to determine the comparative accuracy of risk assessment models (RAMs) for predicting VTE in patients admitted to hospital.MethodsA systematic search was performed across five electronic databases (including MEDLINE, EMBASE and the Cochrane Library) from inception to February 2021. All primary validation studies were eligible if they examined the accuracy of a multivariable RAM (or scoring system) for predicting the risk of developing VTE in hospitalised inpatients. Two or more reviewers independently undertook study selection, data extraction and risk of bias assessments using the PROBAST (Prediction model Risk Of Bias ASsessment Tool) tool. We used narrative synthesis to summarise the findings.ResultsAmong 6355 records, we included 51 studies, comprising 24 unique validated RAMs. The majority of studies included hospital inpatients who required medical care (21 studies), were undergoing surgery (15 studies) or receiving care for trauma (4 studies). The most widely evaluated RAMs were the Caprini RAM (22 studies), Padua prediction score (16 studies), IMPROVE models (8 studies), the Geneva risk score (4 studies) and the Kucher score (4 studies). C-statistics varied markedly between studies and between models, with no one RAM performing obviously better than other models. Across all models, C-statistics were often weak (<0.7), sometimes good (0.7–0.8) and a few were excellent (>0.8). Similarly, estimates for sensitivity and specificity were highly variable. Sensitivity estimates ranged from 12.0% to 100% and specificity estimates ranged from 7.2% to 100%.ConclusionAvailable data suggest that RAMs have generally weak predictive accuracy for VTE. There is insufficient evidence and too much heterogeneity to recommend the use of any particular RAM.PROSPERO registration numberSteve Goodacre, Abdullah Pandor, Katie Sworn, Daniel Horner, Mark Clowes. A systematic review of venous thromboembolism RAMs for hospital inpatients. PROSPERO 2020 CRD42020165778. Available from https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=165778https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=165778

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Risk assessment models for venous thromboembolism in hospitalised adult patients: a systematic review

et al. 2021

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“…While all guidelines discriminated between low‐ and high‐risk women, the actual risk of women considered as high risk remained very modest: the RCOG recommended TPX in 4 out of 10 women, at a mean estimated risk of 0.12%. This risk is much lower than that found in other populations of patients with recommended TPX, such as high‐risk medical inpatients (risk of ~3% 14 ). The ASH discusses TPX in the context of thrombophilia only, as its committee found there was a lack of evidence for other risk factors, explaining the very low proposed TPX 9 …”

Section: Discussionmentioning

confidence: 63%

Estimating the risk thresholds used by guidelines to recommend postpartum thromboprophylaxis

Gassmann

Viviano

Righini

et al. 2021

Journal of Thrombosis and Haemostasis

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Background Guidelines for postpartum thromboprophylaxis are mostly expert based. Acceptable postpartum venous thromboembolism (VTE) risk thresholds to justify the use of thromboprophylaxis are ill defined. Objective To compare the proportion of postpartum women with recommended thromboprophylaxis according to the Royal College of Obstetricians and Gynecologists (RCOG), American College of Obstetricians and Gynecologists (ACOG), and American College of Chest Physicians (ACCP) guidelines, and to estimate their threshold of risk of VTE. Methods We collected maternal, obstetrical, and fetal characteristics among all women who delivered at the Geneva University Hospitals in January 2019 through medical chart review. We determined for each woman the recommended strategy of thromboprophylaxis according to each guideline. We indirectly estimated individual absolute VTE risks using a validated risk prediction model (Sultan). Results Among 344 women (mean age 32.2 years), with 23.3% of cesarean deliveries (CD), the RCOG guideline categorized 40.1% of all deliveries, 25.4% of vaginal deliveries (VD), and 88.8% of CD as requiring thromboprophylaxis. The ACOG and ACCP guidelines, which focus on CD, categorized fewer women as high risk (35.0% and 40.0% of CD, respectively). The mean estimated risk of VTE was 0.07% in all participants, 0.12% in those with recommended thromboprophylaxis according to the RCOG, and 0.20% among women after CD with recommended thromboprophylaxis by the ACOG and ACCP guidelines. Conclusions Our data highlight important variations in the proportion of thromboprophylaxis recommendation between guidelines. Risk thresholds to recommend the use of heparin appear very low, and may correlate with a high, and perhaps undesirable, number needed to treat to prevent VTE events.

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“…We evaluated the Geneva RAM, 6 the Simplified Geneva RAM (sGR), 7,8 the Padua RAM, 9 and the Improve RAM 10 (Table 1), which classify inpatients as low risk or high risk for HA‐VTE. Information on previous VTE, known thrombophilia, active cancer, and body mass index was collected.…”

Section: Methodsmentioning

confidence: 99%

“…We evaluated the Geneva RAM, 6 the Simplified Geneva RAM (sGR), 7,8 the Padua RAM, 9 and the Improve RAM 10 (…”

Section: Definition Of Variablesmentioning

confidence: 99%

Underuse of medical thromboprophylaxis in mobile elderly inpatients: The SWITCO65+ cohort

Blondon¹,

Limacher

Righini³

et al. 2021

Research and Practice in Thrombosis and Haemostasis

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Background Hospital‐associated venous thromboembolism (HA‐VTE) can be prevented by pharmacologic thromboprophylaxis. Thrombotic risk assessment models (RAMs) are essential tools to improve inadequately prescribed thromboprophylaxis. Among cases of HA‐VTE, our study objectives are to explore the classifications of available thrombosis RAMs, the adequacy of thromboprophylaxis and risk factors for inadequate thromboprophylaxis. Methods We identified cases of HA‐VTE occurring during medical hospitalizations within a multicenter Swiss venous thromboembolism (VTE) cohort (2009‐2013). We calculated the proportion of VTE cases deemed at high risk with 4 VTE RAMs (Geneva, Simplified Geneva, Padua, and Improve) and the adequacy of administered pharmacologic thromboprophylaxis, and explored risk factors for underprescription of thromboprophylaxis in high‐risk inpatients. Results Among 66 medical inpatients with HA‐VTE, 60.6% had pulmonary embolism. The sensitivities of the Geneva, Simplified Geneva, Padua, and Improve RAMs were 86.4%, 80.3%, 72.7%, and 57.6%, respectively. The proportion of inadequate thromboprophylaxis was high, as 62.5%‐71.1% of high‐risk inpatients had not received it. Among the high‐risk group according to the Simplified Geneva RAM, absence of immobilization was the only variable significantly associated with an inadequate use of thromboprophylaxis (odds ratio, 3.59; 95% confidence interval, 1.08‐11.88). Conclusions We found a dramatically high proportion of inadequate medical thromboprophylaxis among inpatients who suffered from HA‐VTE. This reinforces the need for global and local quality‐improvement efforts to promote adequate use of thromboprophylaxis in elderly inpatients. Mobility may favor the underuse of thromboprophylaxis, and clinicians should stay alert to other thrombotic risk factors in mobile inpatients.

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External validation of the simplified Geneva risk assessment model for hospital‐associated venous thromboembolism in the Padua cohort

Cited by 11 publications

References 13 publications

Risk assessment models for venous thromboembolism in hospitalised adult patients: a systematic review

Risk assessment models for venous thromboembolism in hospitalised adult patients: a systematic review

Estimating the risk thresholds used by guidelines to recommend postpartum thromboprophylaxis

Underuse of medical thromboprophylaxis in mobile elderly inpatients: The SWITCO65+ cohort

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