Risk Assessment For Vte: All Are Not Equal

Venous Thromboembolism [VTE] risk assessment has become common in most hospitals. However, the comparison of effectiveness between quantitative and qualitative risk assessments is sparse in the literature. We performed a comparative analysis between a quantitative and qualitative assessment in 146 consecutive adult trauma patients. Of the 146 patients enrolled, 64 of whom had no contraindications to VTE prophylaxis, 99 were men and 47 were women. Mean population age was 52.3 years and mean injury severity score [ISS] was 20.0 (+ 9.9). ISS did not correlate with VTE risk. Elderly patients were found to be at higher risk for development of VTE. The non-quantitative risk assessment assigned 38 low risk, 80 moderate risk and 28 high risk patients. Each grouping was re-evaluated to provide a mean quantitative risk for each category of the non-quantitative assessment: 1.5 points for low risk, 3 points for moderate risk, and 3.96 for high risk. Based on recommended guidelines of the quantitative risk score, adequacy of VTE prophylaxis was assessed for each non-quantitative category: 72.2% for low risk, 64.7% for moderate risk and 58.3% for high risk. After re-evaluating all patients using the quantitative risk score, adequacy of VTE prophylaxis was assessed again: 100% for low risk, 83% for moderate risk, 74% for high risk, and 29% for very high risk. We found that the qualitative assessment tended to underscore the risk and therefore resulted in an under-treatment of the highest risk patients. Our data shows that quantitative assessment is superior to qualitative risk assessment.

Validation of the Caprini risk model for predicting deep venous thrombosis in hospital-ized patients with malignant tumors / 中国肿瘤临床

Objective:To evaluate the effectiveness of the Caprini risk assessment model in predicting deep venous thrombosis in hos-pitalized patients with malignant tumors. Methods:Deep venous thrombosis screening was performed in 504 patients with malignant tumors who were hospitalized in Beijing Shijitan Hospital between January 2015 and January 2017. Their Caprini thrombosis risk mod-el scores and risk classifications were analyzed and compared with those of the Khorana risk model. Results:The median Caprini score of patients with deep venous thrombosis was 6 (range 4-8), which was higher than the score of 5 (range 4-7) in the group without deep venous thrombosis (Z=10.033, P=0.004). Statistically significant differences in the incidence of deep venous thrombosis were found among the low-medium, high-, and extremely high-risk groups (Z=-1.933, P=0.053). The area under the receiver-operating char-acteristic curve (AUC) of the Caprini scores was 0.611 [95% confidence interval (CI): 0.54-0.69, P=0.004], and the cutoff value was 6 points, with the largest Youden index. The AUC of the Khorana model was 0.65 (95% CI: 0.57-0.72, P<0.001), and the difference be-tween the Khorana and Caprini models was not statistically significant (Z=0.674, P=0.500). The AUC of the Caprini model was 0.85 (95% CI: 0.66-0.96, P<0.01) and that of the Khorana model was 0.68 (95% CI: 0.47-0.84, P=0.18) in the patients who underwent malig-nant tumor surgery. The AUC of the Khorana model was 0.72 (95% CI: 0.61-0.82, P=0.01) and that of the Caprini model was 0.55 (95% CI: 0.44-0.67, P=0.54) in the non-operative patients who received chemotherapy. Conclusions:The Caprini and Khorana risk assess-ment models have certain predictive values, but the discrimination is not good. The Caprini model is providing better predictability in patients with malignant tumors treated with surgery. The Khorana model is suitable for non-operative patients who received chemo-therapy. Further studies on the application of the Caprini risk assessment model in patients with malignant tumors are needed.

Occurrence of Venous Thromboembolism in Patients with Lung Cancer and Its Anticoagulant Therapy / 中国肺癌杂志

Lung cancer is the first leading cause of morbidity and mortality in the world. Venous thromboembolism (VTE) is a recognized complication in patients with lung cancer, which is one of the leading cause of death in lung cancer patients. The cancer-related, patient-related and treatment-related factors are the main causes of VTE in lung cancer patients. Malignant cells can directly activate blood coagulation by producing tissue factor (TF), cancer procoagulance (CP), inflammatory factors and cytokines; And the one of predominant mechanisms in cancer-related thrombosis is the overexpression of TF. The 10th edition of the antithrombotic therapy guidelines for VTE with cancer patients (AT-10) published in 2016 by American College of Chest Physicians (APCC) recommended that anticoagulant therapy is the basic treatment for patients with lung cancer complicated with VTE; And low molecular-weight-heparin (LMWH) is preferred as an anticoagulant drug, but can be use with caution due to increasing risk of bleeding.
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Application of Caprini risk assessment model for preventing venous thromboembolism / 中国实用护理杂志

Objective To explore the Caprini risk assessment model for the application of the prevention of VTE in clinical nursing. Methods With a cross:sectional survey research, 6 624 patients were interviewed of a hospital from March to June in 2015.The Caprini risk assessment model was used to screen patients with VTE risk assessment. Results Patients have VTE risk in 6 229 cases, accounting for 94.04%. The patients of low risk, moderate risk, high risk, and super high-risk was 1 889 cases, 1 507 cases, 1 930 cases, 903 cases, accounted for 28.52%, 22.75%, 29.14%and 13.64%respectively. Surgical patients with VTE risk, low risk, moderate, high risk and super high-risk rate was 5.15% (79/1 533), 15.72%(241/1 533), 28.77%(441/1 533), 30.59%(469/1 533), 19.77%(303/1 533), the no-surgery group were 6.21% (316/5 091), 32.37% (1 648/5 091), 20.94% (1 066/5 091), 28.68% (1 461/5 091), 11.79%(600/5 091), two groups compare was statistically significant (χ2= 53.46, P = 0.000); High-risk ratio of trauma surgery,thoracic surgery, neurosurgery, orthopedics, mammary gland and thyroid surgery were63.2%、62.9%、61.5%、58.3%、55.8%; High-risk ratio of oncology medical, respiratory medical, neurology medical, cardiology medical were 92.0% , 68.2% , 55.9% and 64.4% . Conclusions Hospitalized patients have high risk of VTE, it is suggested that include VTE in nursing quality evaluation standard, establish an effective system of VTE risk management. Caprini risk assessment model has been clear about the VTE patients should be special attention, and has been great significance to early screening and prevention of VTE.

Venous thromboembolism risk & prophylaxis in the acute hospital care setting (ENDORSE), a multinational cross-sectional study: Results from the Indian subset data.

Background & objectives: Venous thromboembolism (VTE) is a major health problem with substantial morbidity and mortality. It is often underdiagnosed due to lack of information on VTE risk and prophylaxis. The ENDORSE (Epidemiologic International Day for the Evaluation of Patients at Risk for Venous Thromboembolism in the Acute Hospital Care Setting) study aimed to assess the prevalence of VTE risk in acute hospital care setting and proportion of at-risk patients receiving effective prophylaxis. We present here the risk factor profile and prophylaxis pattern of hospitalized patients who participated in ENDORSE study in India. Methods: In this cross-sectional study in India, all patients (surgical >18 yr, medical >40 yr) from 10 hospitals were retrospectively studied. Demographics, VTE risk factors and prophylaxis patterns were assessed according to the 2004 American College of Chest Physicians (ACCP) evidence-based consensus guidelines. Results: We recruited 2058 patients (1110 surgical, 948 medical) from 10 randomly selected hospitals in India between August 2006 and January 2007. According to the ACCP criteria, 1104 (53.6%) patients [surgical 680 (61.3%), medical 424 (44.7%)] were at-risk for VTE. Chronic pulmonary disease/heart failure and complete immobilization were the most common risk factors before and during hospitalization, respectively. In India, 16.3 per cent surgical and 19.1 per cent medical at-risk patients received ACCP-recommended thromboprophylaxis. Interpretation & conclusions: Despite a similar proportion of at-risk hospitalized patients in India and other participating countries, there was major underutilization of prophylaxis in India. It necessitates increasing awareness about VTE risk and ensuring appropriate thromboprophylaxis.

Venous thromboembolism in 13 Indonesian patients undergoing major orthopedic surgery.

Aim To estimate the incidence of VTE in Indonesian patients undergoing major orthopedic surgery and not receiving thromboprophylaxis. Methods This was an open clinical study of consecutive Indonesian patients undergoing major orthopedic surgery, conducted in 3 centers in Jakarta. Bilateral venography was performed between days 5 and 8 after surgery to detect the asymptomatic and to confi rm the symptomatic VTE. These patients were followed up to one month after surgery. Results A total of 17 eligible patients were studied, which a median age of 69 years and 76.5% were females. Sixteen out of the 17 patients (94.1%) underwent hip fracture surgery (HFS). The median time from injury to surgery was 23 days (range 2 to 197 days), the median duration of surgery was 90 minutes (range 60 to 255 minutes), and the median duration of immobilization was 3 days (range 1 to 44 days). Thirteen out of the 17 patients were willing to undergo contrast venography. A symptomatic VTE was found in 9 patients (69.2%) at hospital discharge. Symptomatic VTE was found in 3 patients (23.1%), all corresponding to clinical signs of DVT and none with clinical sign of PE. These patients were treated initially with a low molecular weight heparin, followed by warfarin. Sudden death did not occur up to hospital discharge. From hospital discharge until 1-month follow-up, there were no additional cases of symptomatic VTE. No sudden death, bleeding complication, nor re-hospitalization was found in the present study. Conclusion The incidence of asymptomatic (69.2%) and symptomatic (23.1%) VTE after major orthopedic surgery without thromboprophylaxis in Indonesian patients (SMART and AIDA), and still higher than the results of the Western studies. A larger study is required to establish the true incidence, and more importantly, that the use of thromboprophylaxis in these patients is warranted.