Predictive and Associative Models to Identify Hospitalized Medical Patients at Risk for VTE

Spyropoulos, Alex C.; Anderson, Frederick A.; FitzGerald, Gordon; Décousus, Hervé; Pini, M; Chong, Beng H.; Zotz, Rainer B.; Bergmann, Jean‐François; Tapson, Victor F.; Froehlich, James B.; Monréal, Manuel; Merli, Geno J.; Pavanello, Ricardo; Turpie, Alexander G.G.; Nakamura, Mashio; Piovella, Franco; Kakkar, Ajay K.; Spencer, Frederick A.

doi:10.1378/chest.10-1944

Cited by 450 publications

(492 citation statements)

References 22 publications

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“…Together, the IMPROVE risk assessment models allow continuous assessment of VTE risk over the entire hospital stay. 3 In the IMPROVE cohort, with each of the predictive and associative models, those with a score of 0 to 1 had an observed 90-day incidence of symptomatic VTE less than or equal to 1%, whereas those with a score of 2 or above had a 3-month VTE risk of 2% or higher. 3 Notably, the investigators externally validated the IMPROVE associative risk assessment model in 2 additional databases, both of which showed accurate identification of patients at sufficiently low risk of VTE to omit thromboprophylaxis.…”

Section: Discussionmentioning

confidence: 96%

“…3 In the IMPROVE cohort, with each of the predictive and associative models, those with a score of 0 to 1 had an observed 90-day incidence of symptomatic VTE less than or equal to 1%, whereas those with a score of 2 or above had a 3-month VTE risk of 2% or higher. 3 Notably, the investigators externally validated the IMPROVE associative risk assessment model in 2 additional databases, both of which showed accurate identification of patients at sufficiently low risk of VTE to omit thromboprophylaxis. 11,12 The primary objective of the current study was to compare the proportion of patients considered at high risk for VTE (and Can J Hosp Pharm.…”

Section: Discussionmentioning

confidence: 96%

“…2,3 Various modifiable and nonmodifiable characteristics have been identified as risk factors for VTE, with few being consistently observed across studies. 4 Heparin-based regimens are most often used for thromboprophylaxis in medical inpatients.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, several investigators have developed clinical prediction rules to provide objective, quantifiable estimates of VTE risk based on independent risk factors. 3,9 One such risk assessment model is the Padua Prediction Score, 9 which was endorsed in the ninth edition of the ACCP guidelines. 2 This model was generated empirically by integrating the Kucher model 10 with additional items and by slightly modifying the assigned scores.…”

Section: Discussionmentioning

confidence: 99%

“…9 Another set of risk assessment models included in the ACCP guidelines comes from the international IMPROVE cohort. 3 Based on data for 15 156 prospectively and retrospectively enrolled medical inpatients, 2 variants of the IMPROVE risk assessment model were derived. The first model, termed the IMPROVE predictive model, is based on 4 variables that are typically known at hospital admission, which were independently associated with incidence of VTE up to 90 days after admission (Table 1).…”

Section: Discussionmentioning

confidence: 99%

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Characterization of Venous Thromboembolism Risk in Medical Inpatients Using Different Clinical Risk Assessment Models

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Assessment of the Risk of Venous Thromboembolism in Nonhospitalized Patients With COVID-19

et al. 2023

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ImportancePatients hospitalized with COVID-19 have higher rates of venous thromboembolism (VTE), but the risk and predictors of VTE among individuals with less severe COVID-19 managed in outpatient settings are less well understood.ObjectivesTo assess the risk of VTE among outpatients with COVID-19 and identify independent predictors of VTE.Design, Setting, and ParticipantsA retrospective cohort study was conducted at 2 integrated health care delivery systems in Northern and Southern California. Data for this study were obtained from the Kaiser Permanente Virtual Data Warehouse and electronic health records. Participants included nonhospitalized adults aged 18 years or older with COVID-19 diagnosed between January 1, 2020, and January 31, 2021, with follow-up through February 28, 2021.ExposuresPatient demographic and clinical characteristics identified from integrated electronic health records.Main Outcomes and MeasuresThe primary outcome was the rate per 100 person-years of diagnosed VTE, which was identified using an algorithm based on encounter diagnosis codes and natural language processing. Multivariable regression using a Fine-Gray subdistribution hazard model was used to identify variables independently associated with VTE risk. Multiple imputation was used to address missing data.ResultsA total of 398 530 outpatients with COVID-19 were identified. The mean (SD) age was 43.8 (15.8) years, 53.7% were women, and 54.3% were of self-reported Hispanic ethnicity. There were 292 (0.1%) VTE events identified over the follow-up period, for an overall rate of 0.26 (95% CI, 0.24-0.30) per 100 person-years. The sharpest increase in VTE risk was observed during the first 30 days after COVID-19 diagnosis (unadjusted rate, 0.58; 95% CI, 0.51-0.67 per 100 person-years vs 0.09; 95% CI, 0.08-0.11 per 100 person-years after 30 days). In multivariable models, the following variables were associated with a higher risk for VTE in the setting of nonhospitalized COVID-19: age 55 to 64 years (HR 1.85 [95% CI, 1.26-2.72]), 65 to 74 years (3.43 [95% CI, 2.18-5.39]), 75 to 84 years (5.46 [95% CI, 3.20-9.34]), greater than or equal to 85 years (6.51 [95% CI, 3.05-13.86]), male gender (1.49 [95% CI, 1.15-1.96]), prior VTE (7.49 [95% CI, 4.29-13.07]), thrombophilia (2.52 [95% CI, 1.04-6.14]), inflammatory bowel disease (2.43 [95% CI, 1.02-5.80]), body mass index 30.0-39.9 (1.57 [95% CI, 1.06-2.34]), and body mass index greater than or equal to 40.0 (3.07 [1.95-4.83]).Conclusions and RelevanceIn this cohort study of outpatients with COVID-19, the absolute risk of VTE was low. Several patient-level factors were associated with higher VTE risk; these findings may help identify subsets of patients with COVID-19 who may benefit from more intensive surveillance or VTE preventive strategies.

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Predictive and Associative Models to Identify Hospitalized Medical Patients at Risk for VTE

Cited by 450 publications

References 22 publications

Characterization of Venous Thromboembolism Risk in Medical Inpatients Using Different Clinical Risk Assessment Models

Characterization of Venous Thromboembolism Risk in Medical Inpatients Using Different Clinical Risk Assessment Models

Venous Thromboembolism Prophylaxis for Medical Patients

Assessment of the Risk of Venous Thromboembolism in Nonhospitalized Patients With COVID-19

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