Validating the IMPROVE Venous Thromboembolism (VTE) Risk Score: Retrospective Analysis of Electronic Data From a Large Health System

Rosenberg, David; Eichorn, Ann; Alarcon, Mauricio; McCullagh, Lauren; Spyropoulos, Alex C.

doi:10.1378/chest.1836201

Cited by 2 publications

(3 citation statements)

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“…In this study, there were statistically significant differences between the VTE group and the control group for BMI, tumor type, operation duration, amount of blood loss, need for a blood transfusion, time in bed and history of thrombosis ( P <0.05), while no significant differences were found for age, surgical procedures, or complications. Many studies have shown a significant increase in the incidence of thrombosis in patients with malignant tumors [11,12]. The surgical site for gynecological malignant tumors is located in the pelvic cavity, where the blood vessels are abundant, making it easy to cause vascular injury during the operation.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Risk Factors for Venous Thromboembolism in Patients Who Underwent Gynecological Surgery and Validation of a Fast-Rating Assessment Table

et al. 2019

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BackgroundThe aim of this study was to retrospectively analyze the risk factors for venous thromboembolism (VTE) in gynecological patients and verify the validity of a fast-rating assessment table.Material/MethodsFrom October 2015 to October 2017, 53 patients complicated with VTE after gynecological operations were analyzed, and a total of 106 patients with 2 adjacent operations were selected as the control group. Factors such as age, body mass index (BMI), and tumor type were analyzed by univariate and multivariate analysis. A fast-rating assessment table of VTE risk factors was constructed. This fast-rating assessment table and the Caprini score table were used to compare the scores of all patients.ResultsIn the univariate analysis, there were significant differences in BMI, tumor type, operation duration, blood loss, blood transfusion, bed rest time, and thrombus-related history between the 2 groups. In the multiple factor analysis, age >60 years old, BMI >28 kg/m2, malignant tumors, operation duration ≥3 hours, laparoscopic surgery and thrombus-related history were independent risk factors for VTE in patients. Both the fast-rating assessment table and the Caprini score table identified 90% of VTE patients as high-risk and very high-risk, and there was no significant difference between the tables.ConclusionsPatients with older age, high BMI, malignant tumors, longer operation duration, laparoscopic surgery, or history of thrombosis may be more prone to VTE after gynecologic surgery. The fast-rating assessment table is easy to operate and has a high recognition level for VTE. It can be applied widely.

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Section: Discussionmentioning

confidence: 99%

Evaluation of Risk Factors for Venous Thromboembolism in Patients Who Underwent Gynecological Surgery and Validation of a Fast-Rating Assessment Table

et al. 2019

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“…30,31 The only bleeding risk assessment model-the IMPROVE model-which has been specifically validated in hospitalized medically ill patients incorporates many of the bleeding risk factors in the present study and corroborates our observation that approximately 10% to 20% of medically ill patients would be at high risk of bleeding from pharmacologic thromboprophylactic measures. 32,33 An important observation comes from 2 recent randomized trials of acutely ill medical patients. The MARINER trial prospectively tested whether the 5 key additional exclusionary criteria found in this analysis could improve the benefit risk profile of rivaroxaban in a postdischarge setting.…”

Section: Discussionmentioning

confidence: 99%

“…30,31 The only bleeding risk assessment model—the IMPROVE model—which has been specifically validated in hospitalized medically ill patients incorporates many of the bleeding risk factors in the present study and corroborates our observation that approximately 10% to 20% of medically ill patients would be at high risk of bleeding from pharmacologic thromboprophylactic measures. 32,33…”

Section: Discussionmentioning

confidence: 99%

Improved Benefit Risk Profile of Rivaroxaban in a Subpopulation of the MAGELLAN Study

Spyropoulos

Lipardi

et al. 2019

Clin Appl Thromb Hemost

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Acutely ill medical patients are at risk of venous thromboembolism (VTE) and VTE-related mortality during hospitalization and posthospital discharge, but widespread adoption of extended thromboprophylaxis has not occurred. We analyzed a subpopulation within the MAGELLAN study of extended thromboprophylaxis with rivaroxaban to reevaluate the benefit risk profile. We identified 5 risk factors for major and fatal bleeding after a clinical analysis of the MAGELLAN study and analyzed efficacy and safety with these patients excluded (n = 1551). Risk factors included: active cancer, dual antiplatelet therapy at baseline, bronchiectasis/pulmonary cavitation, gastroduodenal ulcer, or bleeding within 3 months before randomization. We evaluated efficacy, safety, and benefit risk using clinically comparable endpoints in the subpopulation. At day 10, rivaroxaban was noninferior to enoxaparin (relative risk [RR] = 0.82, 95% confidence interval [CI] = 0.58-1.15) and at day 35 rivaroxaban was significantly better than enoxaparin/placebo (RR = 0.68, 95% CI = 0.53-0.88) in reducing VTE and VTE-related death. Major bleeding was reduced at day 10 (RR = 2.18, 95% CI = 1.07-4.44 vs 1.19, 95% CI = 0.54-2.65) and at day 35 (2.87, 95% CI = 1.60-5.15 vs 1.48, 95% CI = 0.77-2.84) for MAGELLAN versus this subpopulation, respectively. The benefit risk profile was favorable in this subpopulation treated for 35 days, with the number needed to treat ranging from 55 to 481 and number needed to harm from 455 to 1067 for all pairwise evaluations. Five exclusionary criteria defined a subpopulation of acutely ill medical patients with a positive benefit risk profile for in-hospital and extended thromboprophylaxis with rivaroxaban.

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Validating the IMPROVE Venous Thromboembolism (VTE) Risk Score: Retrospective Analysis of Electronic Data From a Large Health System

Cited by 2 publications

References 0 publications

Evaluation of Risk Factors for Venous Thromboembolism in Patients Who Underwent Gynecological Surgery and Validation of a Fast-Rating Assessment Table

Evaluation of Risk Factors for Venous Thromboembolism in Patients Who Underwent Gynecological Surgery and Validation of a Fast-Rating Assessment Table

Improved Benefit Risk Profile of Rivaroxaban in a Subpopulation of the MAGELLAN Study

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