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

Javier Trujillo-Santos; Francisco Lozano; Manuel Alejandro Lorente; Dolores Adarraga; Jana Hirmerova; Jorge Del Toro; Lucia Mazzolai; Giovanni Barillari; Manuel Barrón; Manuel Monreal; M. Alcalde; V. Andújar; J. I. Arcelus; R. Barba; B. Barrón-Andrés; J. Bascuñana; A. Blanco-Molina; T. Bueso; I. Casado; A. Climent; F. Conget; Molino F. Del; C. Falgá; C. Fernández-Capitán; L. Font; P. Gallego; F. García-Bragado; V. Gómez; J. González; E. González-Bachs; E. Grau; R. Guijarro; M. Guil; J. Gutiérrez; L. Jara-Palomares; M. J. Jaras; D. Jiménez; R. Jiménez; R. Lecumberri; J. L. Lobo; L. López-Jiménez; L. López-Montes; R. López-Reyes; J. B. López-Sáez; A. Lorenzo; J. M. Luque; O. Madridano; P. J. Marchena; J. M. Martín-Antorán; M. Mellado; M. V. Morales; D. Nauffal; J. A. Nieto; M. J. Núñez; J. L. Ogea; R. Otero; B. Pagán; J. M. Pedrajas; G. Pérez-Rus; M. L. Peris; J. A. Porras; I. Pons; A. Riera-Mestre; A. Rivas; M. A. Rodríguez-Dávila; P. Román; V. Rosa; N. Ruiz-Giménez; J. Ruiz; P. Sabio; A. Samperiz; R. Sánchez; S. Soler; J. M. Suriñach; G. Tiberio; F. Uresandi; B. Valero; R. Valle; J. Vela; A. Villalobos; P. Malfante; P. Verhamme; K. Peerlinck; P. Wells; R. Malý; M. Kaletova; T. Tomko; L. Bertoletti; A. Bura-Riviere; M. Farès; C. Grange; I. Mahe; A. Merah; I. Quere; S. Schellong; M. Papadakis; A. Braester; B. Brenner; I. Tzoran; D. Zeltser; A. Apollonio; M. Ciammaichella; Micco P. Di; R. Duce; A. Guida; R. Maida; F. Pace; S. Pasca; C. Piovella; R. Pesavento; R. Poggio; P. Prandoni; L. Rota; E. Tiraferri; D. Tonello; A. Tufano; A. Visonà; B. Zalunardo; S. Almeida; F. Leal-Seabra; M. S. Sousa; M. Bosevski; A. Alatri; H. Bounameaux; L. Calanca; J. C. Serrano

doi:10.1016/j.amjmed.2014.08.023

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

Javier Trujillo-Santos, Francisco Lozano, Manuel Alejandro Lorente, Dolores Adarraga, Jana Hirmerova, Jorge Del Toro, Lucia Mazzolai, Giovanni Barillari, Manuel Barrón, Manuel Monreal, M. Alcalde, V. Andújar, J. I. Arcelus, R. Barba, B. Barrón-Andrés, J. Bascuñana, A. Blanco-Molina, T. Bueso, I. Casado, A. ClimentF. Conget, Molino F. Del, C. Falgá, C. Fernández-Capitán, L. Font, P. Gallego, F. García-Bragado, V. Gómez, J. González, E. González-Bachs, E. Grau, R. Guijarro, M. Guil, J. Gutiérrez, L. Jara-Palomares, M. J. Jaras, D. Jiménez, R. Jiménez, R. Lecumberri, J. L. Lobo, L. López-Jiménez, L. López-Montes, R. López-Reyes, J. B. López-Sáez, A. Lorenzo, J. M. Luque, O. Madridano, P. J. Marchena, J. M. Martín-Antorán, M. Mellado, M. V. Morales, D. Nauffal, J. A. Nieto, M. J. Núñez, J. L. Ogea, R. Otero, B. Pagán, J. M. Pedrajas, G. Pérez-Rus, M. L. Peris, J. A. Porras, I. Pons, A. Riera-Mestre, A. Rivas, M. A. Rodríguez-Dávila, P. Román, V. Rosa, N. Ruiz-Giménez, J. Ruiz, P. Sabio, A. Samperiz, R. Sánchez, S. Soler, J. M. Suriñach, G. Tiberio, F. Uresandi, B. Valero, R. Valle, J. Vela, A. Villalobos, P. Malfante, P. Verhamme, K. Peerlinck, P. Wells, R. Malý, M. Kaletova, T. Tomko, L. Bertoletti, A. Bura-Riviere, M. Farès, C. Grange, I. Mahe, A. Merah, I. Quere, S. Schellong, M. Papadakis, A. Braester, B. Brenner, I. Tzoran, D. Zeltser, A. Apollonio, M. Ciammaichella, Micco P. Di, R. Duce, A. Guida, R. Maida, F. Pace, S. Pasca, C. Piovella, R. Pesavento, R. Poggio, P. Prandoni, L. Rota, E. Tiraferri, D. Tonello, A. Tufano, A. Visonà, B. Zalunardo, S. Almeida, F. Leal-Seabra, M. S. Sousa, M. Bosevski, A. Alatri, H. Bounameaux, L. Calanca, J. C. Serrano

Bar-Ilan University - Azrieli Faculty of Medicine

Research output: Contribution to journal › Article › peer-review

11 Scopus citations

Abstract

BACKGROUND: No prior studies have identified which patients with deep vein thrombosis in the lower limbs are at a low risk for adverse events within the first week of therapy. METHODS: We used data from the Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) to identify patients at low risk for the composite outcome of pulmonary embolism, major bleeding, or death within the first week. We built a prognostic score and compared it with the decision to treat patients at home. RESULTS: As of December 2013, 15,280 outpatients with deep vein thrombosis had been enrolled. Overall, 5164 patients (34%) were treated at home. Of these, 12 (0.23%) had pulmonary embolism, 8 (0.15%) bled, and 4 (0.08%) died. On multivariable analysis, chronic heart failure, recent immobility, recent bleeding, cancer, renal insufficiency, and abnormal platelet count independently predicted the risk for the composite outcome. Among 11,430 patients (75%) considered to be at low risk, 15 (0.13%) suffered pulmonary embolism, 22 (0.19%) bled, and 8 (0.07%) died. The C-statistic was 0.61 (95% confidence interval [CI], 0.57-0.65) for the decision to treat patients at home and 0.76 (95% CI, 0.72-0.79) for the score (P = .003). Net reclassification improvement was 41% (P < .001). Integrated discrimination improvement was 0.034 for the score and 0.015 for the clinical decision (P < .001). CONCLUSIONS: Using 6 easily available variables, we identified outpatients with deep vein thrombosis at low risk for adverse events within the first week. These data may help to safely treat more patients at home. This score, however, should be validated.

Original language	English
Pages (from-to)	90.e9-90.e15
Journal	American Journal of Medicine
Volume	128
Issue number	1
DOIs	https://doi.org/10.1016/j.amjmed.2014.08.023
State	Published - Jan 2015

Bibliographical note

Publisher Copyright:
© 2015 Elsevier Inc. All rights reserved.

Keywords

Anticoagulant therapy
Deep venous thrombosis
Home
Hospital
Outcome

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1016/j.amjmed.2014.08.023

Cite this

Trujillo-Santos, J., Lozano, F., Lorente, M. A., Adarraga, D., Hirmerova, J., Toro, J. D., Mazzolai, L., Barillari, G., Barrón, M., Monreal, M., Alcalde, M., Andújar, V., Arcelus, J. I., Barba, R., Barrón-Andrés, B., Bascuñana, J., Blanco-Molina, A., Bueso, T., Casado, I., ... Serrano, J. C. (2015). A prognostic score to identify low-risk outpatients with acute deep vein thrombosis in the lower limbs. American Journal of Medicine, 128(1), 90.e9-90.e15. https://doi.org/10.1016/j.amjmed.2014.08.023

@article{aa5db28717544846ada7fdb15acbf588,

title = "A prognostic score to identify low-risk outpatients with acute deep vein thrombosis in the lower limbs",

abstract = "BACKGROUND: No prior studies have identified which patients with deep vein thrombosis in the lower limbs are at a low risk for adverse events within the first week of therapy. METHODS: We used data from the Registro Informatizado de la Enfermedad TromboEmb{\'o}lica (RIETE) to identify patients at low risk for the composite outcome of pulmonary embolism, major bleeding, or death within the first week. We built a prognostic score and compared it with the decision to treat patients at home. RESULTS: As of December 2013, 15,280 outpatients with deep vein thrombosis had been enrolled. Overall, 5164 patients (34%) were treated at home. Of these, 12 (0.23%) had pulmonary embolism, 8 (0.15%) bled, and 4 (0.08%) died. On multivariable analysis, chronic heart failure, recent immobility, recent bleeding, cancer, renal insufficiency, and abnormal platelet count independently predicted the risk for the composite outcome. Among 11,430 patients (75%) considered to be at low risk, 15 (0.13%) suffered pulmonary embolism, 22 (0.19%) bled, and 8 (0.07%) died. The C-statistic was 0.61 (95% confidence interval [CI], 0.57-0.65) for the decision to treat patients at home and 0.76 (95% CI, 0.72-0.79) for the score (P = .003). Net reclassification improvement was 41% (P < .001). Integrated discrimination improvement was 0.034 for the score and 0.015 for the clinical decision (P < .001). CONCLUSIONS: Using 6 easily available variables, we identified outpatients with deep vein thrombosis at low risk for adverse events within the first week. These data may help to safely treat more patients at home. This score, however, should be validated.",

keywords = "Anticoagulant therapy, Deep venous thrombosis, Home, Hospital, Outcome",

author = "Javier Trujillo-Santos and Francisco Lozano and Lorente, {Manuel Alejandro} and Dolores Adarraga and Jana Hirmerova and Toro, {Jorge Del} and Lucia Mazzolai and Giovanni Barillari and Manuel Barr{\'o}n and Manuel Monreal and M. Alcalde and V. And{\'u}jar and Arcelus, {J. I.} and R. Barba and B. Barr{\'o}n-Andr{\'e}s and J. Bascu{\~n}ana and A. Blanco-Molina and T. Bueso and I. Casado and A. Climent and F. Conget and Del, {Molino F.} and C. Falg{\'a} and C. Fern{\'a}ndez-Capit{\'a}n and L. Font and P. Gallego and F. Garc{\'i}a-Bragado and V. G{\'o}mez and J. Gonz{\'a}lez and E. Gonz{\'a}lez-Bachs and E. Grau and R. Guijarro and M. Guil and J. Guti{\'e}rrez and L. Jara-Palomares and Jaras, {M. J.} and D. Jim{\'e}nez and R. Jim{\'e}nez and R. Lecumberri and Lobo, {J. L.} and L. L{\'o}pez-Jim{\'e}nez and L. L{\'o}pez-Montes and R. L{\'o}pez-Reyes and L{\'o}pez-S{\'a}ez, {J. B.} and A. Lorenzo and Luque, {J. M.} and O. Madridano and Marchena, {P. J.} and Mart{\'i}n-Antor{\'a}n, {J. M.} and M. Mellado and Morales, {M. V.} and D. Nauffal and Nieto, {J. A.} and N{\'u}{\~n}ez, {M. J.} and Ogea, {J. L.} and R. Otero and B. Pag{\'a}n and Pedrajas, {J. M.} and G. P{\'e}rez-Rus and Peris, {M. L.} and Porras, {J. A.} and I. Pons and A. Riera-Mestre and A. Rivas and Rodr{\'i}guez-D{\'a}vila, {M. A.} and P. Rom{\'a}n and V. Rosa and N. Ruiz-Gim{\'e}nez and J. Ruiz and P. Sabio and A. Samperiz and R. S{\'a}nchez and S. Soler and Suri{\~n}ach, {J. M.} and G. Tiberio and F. Uresandi and B. Valero and R. Valle and J. Vela and A. Villalobos and P. Malfante and P. Verhamme and K. Peerlinck and P. Wells and R. Mal{\'y} and M. Kaletova and T. Tomko and L. Bertoletti and A. Bura-Riviere and M. Far{\`e}s and C. Grange and I. Mahe and A. Merah and I. Quere and S. Schellong and M. Papadakis and A. Braester and B. Brenner and I. Tzoran and D. Zeltser and A. Apollonio and M. Ciammaichella and Di, {Micco P.} and R. Duce and A. Guida and R. Maida and F. Pace and S. Pasca and C. Piovella and R. Pesavento and R. Poggio and P. Prandoni and L. Rota and E. Tiraferri and D. Tonello and A. Tufano and A. Vison{\`a} and B. Zalunardo and S. Almeida and F. Leal-Seabra and Sousa, {M. S.} and M. Bosevski and A. Alatri and H. Bounameaux and L. Calanca and Serrano, {J. C.}",

year = "2015",

month = jan,

doi = "10.1016/j.amjmed.2014.08.023",

language = "אנגלית",

volume = "128",

pages = "90.e9--90.e15",

journal = "American Journal of Medicine",

issn = "0002-9343",

publisher = "Elsevier Inc.",

number = "1",

}

Trujillo-Santos, J, Lozano, F, Lorente, MA, Adarraga, D, Hirmerova, J, Toro, JD, Mazzolai, L, Barillari, G, Barrón, M, Monreal, M, Alcalde, M, Andújar, V, Arcelus, JI, Barba, R, Barrón-Andrés, B, Bascuñana, J, Blanco-Molina, A, Bueso, T, Casado, I, Climent, A, Conget, F, Del, MF, Falgá, C, Fernández-Capitán, C, Font, L, Gallego, P, García-Bragado, F, Gómez, V, González, J, González-Bachs, E, Grau, E, Guijarro, R, Guil, M, Gutiérrez, J, Jara-Palomares, L, Jaras, MJ, Jiménez, D, Jiménez, R, Lecumberri, R, Lobo, JL, López-Jiménez, L, López-Montes, L, López-Reyes, R, López-Sáez, JB, Lorenzo, A, Luque, JM, Madridano, O, Marchena, PJ, Martín-Antorán, JM, Mellado, M, Morales, MV, Nauffal, D, Nieto, JA, Núñez, MJ, Ogea, JL, Otero, R, Pagán, B, Pedrajas, JM, Pérez-Rus, G, Peris, ML, Porras, JA, Pons, I, Riera-Mestre, A, Rivas, A, Rodríguez-Dávila, MA, Román, P, Rosa, V, Ruiz-Giménez, N, Ruiz, J, Sabio, P, Samperiz, A, Sánchez, R, Soler, S, Suriñach, JM, Tiberio, G, Uresandi, F, Valero, B, Valle, R, Vela, J, Villalobos, A, Malfante, P, Verhamme, P, Peerlinck, K, Wells, P, Malý, R, Kaletova, M, Tomko, T, Bertoletti, L, Bura-Riviere, A, Farès, M, Grange, C, Mahe, I, Merah, A, Quere, I, Schellong, S, Papadakis, M, Braester, A, Brenner, B, Tzoran, I, Zeltser, D, Apollonio, A, Ciammaichella, M, Di, MP, Duce, R, Guida, A, Maida, R, Pace, F, Pasca, S, Piovella, C, Pesavento, R, Poggio, R, Prandoni, P, Rota, L, Tiraferri, E, Tonello, D, Tufano, A, Visonà, A, Zalunardo, B, Almeida, S, Leal-Seabra, F, Sousa, MS, Bosevski, M, Alatri, A, Bounameaux, H, Calanca, L & Serrano, JC 2015, 'A prognostic score to identify low-risk outpatients with acute deep vein thrombosis in the lower limbs', American Journal of Medicine, vol. 128, no. 1, pp. 90.e9-90.e15. https://doi.org/10.1016/j.amjmed.2014.08.023

TY - JOUR

T1 - A prognostic score to identify low-risk outpatients with acute deep vein thrombosis in the lower limbs

AU - Trujillo-Santos, Javier

AU - Lozano, Francisco

AU - Lorente, Manuel Alejandro

AU - Adarraga, Dolores

AU - Hirmerova, Jana

AU - Toro, Jorge Del

AU - Mazzolai, Lucia

AU - Barillari, Giovanni

AU - Barrón, Manuel

AU - Monreal, Manuel

AU - Alcalde, M.

AU - Andújar, V.

AU - Arcelus, J. I.

AU - Barba, R.

AU - Barrón-Andrés, B.

AU - Bascuñana, J.

AU - Blanco-Molina, A.

AU - Bueso, T.

AU - Casado, I.

AU - Climent, A.

AU - Conget, F.

AU - Del, Molino F.

AU - Falgá, C.

AU - Fernández-Capitán, C.

AU - Font, L.

AU - Gallego, P.

AU - García-Bragado, F.

AU - Gómez, V.

AU - González, J.

AU - González-Bachs, E.

AU - Grau, E.

AU - Guijarro, R.

AU - Guil, M.

AU - Gutiérrez, J.

AU - Jara-Palomares, L.

AU - Jaras, M. J.

AU - Jiménez, D.

AU - Jiménez, R.

AU - Lecumberri, R.

AU - Lobo, J. L.

AU - López-Jiménez, L.

AU - López-Montes, L.

AU - López-Reyes, R.

AU - López-Sáez, J. B.

AU - Lorenzo, A.

AU - Luque, J. M.

AU - Madridano, O.

AU - Marchena, P. J.

AU - Martín-Antorán, J. M.

AU - Mellado, M.

AU - Morales, M. V.

AU - Nauffal, D.

AU - Nieto, J. A.

AU - Núñez, M. J.

AU - Ogea, J. L.

AU - Otero, R.

AU - Pagán, B.

AU - Pedrajas, J. M.

AU - Pérez-Rus, G.

AU - Peris, M. L.

AU - Porras, J. A.

AU - Pons, I.

AU - Riera-Mestre, A.

AU - Rivas, A.

AU - Rodríguez-Dávila, M. A.

AU - Román, P.

AU - Rosa, V.

AU - Ruiz-Giménez, N.

AU - Ruiz, J.

AU - Sabio, P.

AU - Samperiz, A.

AU - Sánchez, R.

AU - Soler, S.

AU - Suriñach, J. M.

AU - Tiberio, G.

AU - Uresandi, F.

AU - Valero, B.

AU - Valle, R.

AU - Vela, J.

AU - Villalobos, A.

AU - Malfante, P.

AU - Verhamme, P.

AU - Peerlinck, K.

AU - Wells, P.

AU - Malý, R.

AU - Kaletova, M.

AU - Tomko, T.

AU - Bertoletti, L.

AU - Bura-Riviere, A.

AU - Farès, M.

AU - Grange, C.

AU - Mahe, I.

AU - Merah, A.

AU - Quere, I.

AU - Schellong, S.

AU - Papadakis, M.

AU - Braester, A.

AU - Brenner, B.

AU - Tzoran, I.

AU - Zeltser, D.

AU - Apollonio, A.

AU - Ciammaichella, M.

AU - Di, Micco P.

AU - Duce, R.

AU - Guida, A.

AU - Maida, R.

AU - Pace, F.

AU - Pasca, S.

AU - Piovella, C.

AU - Pesavento, R.

AU - Poggio, R.

AU - Prandoni, P.

AU - Rota, L.

AU - Tiraferri, E.

AU - Tonello, D.

AU - Tufano, A.

AU - Visonà, A.

AU - Zalunardo, B.

AU - Almeida, S.

AU - Leal-Seabra, F.

AU - Sousa, M. S.

AU - Bosevski, M.

AU - Alatri, A.

AU - Bounameaux, H.

AU - Calanca, L.

AU - Serrano, J. C.

PY - 2015/1

Y1 - 2015/1

N2 - BACKGROUND: No prior studies have identified which patients with deep vein thrombosis in the lower limbs are at a low risk for adverse events within the first week of therapy. METHODS: We used data from the Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) to identify patients at low risk for the composite outcome of pulmonary embolism, major bleeding, or death within the first week. We built a prognostic score and compared it with the decision to treat patients at home. RESULTS: As of December 2013, 15,280 outpatients with deep vein thrombosis had been enrolled. Overall, 5164 patients (34%) were treated at home. Of these, 12 (0.23%) had pulmonary embolism, 8 (0.15%) bled, and 4 (0.08%) died. On multivariable analysis, chronic heart failure, recent immobility, recent bleeding, cancer, renal insufficiency, and abnormal platelet count independently predicted the risk for the composite outcome. Among 11,430 patients (75%) considered to be at low risk, 15 (0.13%) suffered pulmonary embolism, 22 (0.19%) bled, and 8 (0.07%) died. The C-statistic was 0.61 (95% confidence interval [CI], 0.57-0.65) for the decision to treat patients at home and 0.76 (95% CI, 0.72-0.79) for the score (P = .003). Net reclassification improvement was 41% (P < .001). Integrated discrimination improvement was 0.034 for the score and 0.015 for the clinical decision (P < .001). CONCLUSIONS: Using 6 easily available variables, we identified outpatients with deep vein thrombosis at low risk for adverse events within the first week. These data may help to safely treat more patients at home. This score, however, should be validated.

AB - BACKGROUND: No prior studies have identified which patients with deep vein thrombosis in the lower limbs are at a low risk for adverse events within the first week of therapy. METHODS: We used data from the Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) to identify patients at low risk for the composite outcome of pulmonary embolism, major bleeding, or death within the first week. We built a prognostic score and compared it with the decision to treat patients at home. RESULTS: As of December 2013, 15,280 outpatients with deep vein thrombosis had been enrolled. Overall, 5164 patients (34%) were treated at home. Of these, 12 (0.23%) had pulmonary embolism, 8 (0.15%) bled, and 4 (0.08%) died. On multivariable analysis, chronic heart failure, recent immobility, recent bleeding, cancer, renal insufficiency, and abnormal platelet count independently predicted the risk for the composite outcome. Among 11,430 patients (75%) considered to be at low risk, 15 (0.13%) suffered pulmonary embolism, 22 (0.19%) bled, and 8 (0.07%) died. The C-statistic was 0.61 (95% confidence interval [CI], 0.57-0.65) for the decision to treat patients at home and 0.76 (95% CI, 0.72-0.79) for the score (P = .003). Net reclassification improvement was 41% (P < .001). Integrated discrimination improvement was 0.034 for the score and 0.015 for the clinical decision (P < .001). CONCLUSIONS: Using 6 easily available variables, we identified outpatients with deep vein thrombosis at low risk for adverse events within the first week. These data may help to safely treat more patients at home. This score, however, should be validated.

KW - Anticoagulant therapy

KW - Deep venous thrombosis

KW - Home

KW - Hospital

KW - Outcome

UR - http://www.scopus.com/inward/record.url?scp=84925287041&partnerID=8YFLogxK

U2 - 10.1016/j.amjmed.2014.08.023

DO - 10.1016/j.amjmed.2014.08.023

M3 - ???researchoutput.researchoutputtypes.contributiontojournal.article???

C2 - 25242230

AN - SCOPUS:84925287041

SN - 0002-9343

VL - 128

SP - 90.e9-90.e15

JO - American Journal of Medicine

JF - American Journal of Medicine

IS - 1

ER -

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

Abstract

Bibliographical note

Keywords

UN SDGs

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