A Prognostic Score to Identify Low-risk Outpatients with Acute Deep Vein Thrombosis in the Lower Limbs.
Détails
ID Serval
serval:BIB_A3669171DD27
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
A Prognostic Score to Identify Low-risk Outpatients with Acute Deep Vein Thrombosis in the Lower Limbs.
Périodique
American Journal of Medicine
Collaborateur⸱rice⸱s
RIETE Investigators, RIETE Investigators
Contributeur⸱rice⸱s
Adarraga MD., Alcalde M., Andújar V., Arcelus JI., Barba R., Barrón M., Barrón-Andrés B., Bascuñana J., Blanco-Molina A., Bueso T., Casado I., Climent A., Conget F., Del Molino F., Del Toro J., 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., Lorente MA., Lorenzo A., Luque JM., Madridano O., Marchena PJ., Martín-Antorán JM., Mellado M., Monreal 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., Trujillo-Santos J., Uresandi F., Valero B., Valle R., Vela J., Villalobos A., Malfante P., Verhamme P., Peerlinck K., Wells P., Malý R., Hirmerova J., 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., Barillari G., Ciammaichella M., Di Micco P., 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., Mazzolai L., Serrano JC.
ISSN
1555-7162 (Electronic)
ISSN-L
0002-9343
Statut éditorial
Publié
Date de publication
2015
Peer-reviewed
Oui
Volume
128
Numéro
1
Pages
90.e9-90.e15
Langue
anglais
Notes
Publication types: Journal Article
Résumé
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.
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.
Pubmed
Web of science
Création de la notice
28/11/2014 16:26
Dernière modification de la notice
02/06/2020 15:15
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