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

V. Rosa-Salazar, J. Trujillo-Santos, J. A. Díaz Peromingo, A. Apollonio, O. Sanz, R. Malý, F. J. Muñoz-Rodriguez, J. C. Serrano, S. Soler, M. Monreal, H. Decousus, P. Prandoni, B. Brenner, R. Barba, P. Di Micco, L. Bertoletti, S. Schellong, I. Tzoran, A. Reis, M. BosevskiH. Bounameaux, P. Wells, M. Papadakis, M. D. Adarraga, A. Alibalic, A. Alvarado-Faria, J. I. Arcelus, T. Auguet, A. Ballaz, R. Barba, M. Barrón, B. Barrón-Andrés, J. Bascuñana, J. F. Benítez, A. Blanco-Molina, T. Bueso, A. Cañas, A. Casado, N. Castejón-Pina, E. L. Chaves, F. del Molino, J. del Toro, J. A. Díaz, C. Falgá, C. Fernández-Capitán, L. Font, P. Gallego, F. García-Bragado, A. García-Ortega, V. Gómez, J. González, D. González-Marcano, E. Grau, R. Guijarro, M. Guil, L. Guirado, J. Gutiérrez-Guisado, L. Hernández-Blasco, L. Jara-Palomares, M. J. Jaras, D. Jiménez, R. Jiménez, B. Lacruz, R. Lecumberri, J. L. Lobo, L. López-Jiménez, L. López-Montes, R. López-Reyes, J. B. López-Sáez, M. A. Lorente, A. Lorenzo, O. Madridano, A. Maestre, P. J. Marchena, J. M. Martín-Antorán, F. Martín-Martos, M. Montreal, M. V. Morales, D. Nauffal, J. A. Nieto, M. J. Núñez, S. Otalora, R. Otero, B. Pagán, J. M. Pedrajas, M. L. Peris, I. Pons, J. A. Porras, A. Riera-Mestre, A. Rivas, M. A. Rodríguez-Dávila, V. Rosa, N. Ruiz-Giménez, P. Sabio, A. Sampériz, R. Sánchez, M. J. Soto, J. M. Suriñach, G. Tiberio, R. Tirado, C. Tolosa, F. Uresandi, B. Valero, R. Valle, J. Vela, A. Villalobos, J. Villalta, P. Malfante, P. Verhamme, T. Vanassche, P. Wells, T. Tomko, J. Hirmerova, L. Bertoletti, A. Bura-Riviere, D. Farge-Bance, A. Hij, I. Mahe, A. Merah, F. Moustafa, I. Quere, S. Schellong, D. Babalis, M. Papadakis, I. Tzinieris, A. Braester, B. Brenner, I. Tzoran, G. Barillari, E. Bucherini, J. Campodomico, M. Ciammaichella, P. Di Micco, P. Ferrazzi, R. Maida, F. Pace, S. Pasca, R. Pesavento, C. Piovella, P. Prandoni, L. Rota, E. Tiraferri, A. Tufano, A. Visoná, A. Skride, A. Belovs, M. Moreira, J. L. Ribeiro, M. S. Sousa, M. Bosevski, A. Alatri, H. Bounameaux, L. Calanca, L. Mazzolai

Research output: Contribution to journalArticle

Abstract

Background: No studies have identified which patients with upper-extremity deep vein thrombosis (DVT) are at low risk for adverse events within the first week of therapy. Methods: We used data from Registro Informatizado de la Enfermedad TromboEmbólica to explore in patients with upper-extremity DVT a prognostic score that correctly identified patients with lower limb DVT at low risk for pulmonary embolism, major bleeding, or death within the first week. Results: As of December 2014, 1135 outpatients with upper-extremity DVT were recruited. Of these, 515 (45%) were treated at home. During the first week, three patients (0.26%) experienced pulmonary embolism, two (0.18%) had major bleeding, and four (0.35%) died. We assigned 1 point to patients with chronic heart failure, creatinine clearance levels 30-60 mL min-1, recent bleeding, abnormal platelet count, recent immobility, or cancer without metastases; 2 points to those with metastatic cancer; and 3 points to those with creatinine clearance levels <30 mL min-1. Overall, 759 (67%) patients scored ≤ 1 point and were considered to be at low risk. The rate of the composite outcome within the first week was 0.26% (95% confidence interval [CI] 0.004-0.87) in patients at low risk and 1.86% (95% CI 0.81-3.68) in the remaining patients. C-statistics was 0.73 (95% CI 0.57-0.88). Net reclassification improvement was 22%, and integrated discrimination improvement was 0.0055. Conclusions: Using six easily available variables, we identified outpatients with upper-extremity DVT at low risk for adverse events within the first week. These data may help to safely treat more patients at home.

Original languageEnglish
Pages (from-to)1274-1278
Number of pages5
JournalJournal of Thrombosis and Haemostasis
Volume13
Issue number7
DOIs
Publication statusPublished - Jul 1 2015

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Keywords

  • Anticoagulant therapy
  • Deep vein thrombosis
  • Hospital
  • Outcome
  • Outpatients
  • Upper extremity

ASJC Scopus subject areas

  • Hematology

Cite this

Rosa-Salazar, V., Trujillo-Santos, J., Díaz Peromingo, J. A., Apollonio, A., Sanz, O., Malý, R., Muñoz-Rodriguez, F. J., Serrano, J. C., Soler, S., Monreal, M., Decousus, H., Prandoni, P., Brenner, B., Barba, R., Di Micco, P., Bertoletti, L., Schellong, S., Tzoran, I., Reis, A., ... Mazzolai, L. (2015). A prognostic score to identify low-risk outpatients with acute deep vein thrombosis in the upper extremity. Journal of Thrombosis and Haemostasis, 13(7), 1274-1278. https://doi.org/10.1111/jth.13008