Rosenberg David, Eichorn Ann, Alarcon Mauricio, McCullagh Lauren, McGinn Thomas, Spyropoulos Alex C
Department of Medicine, Hofstra North Shore LIJ School of Medicine, Manhasset, NY (D.R., M.A., L.M.C., T.M.G., A.C.S.).
Krasnoff Quality Management Institute, North Shore LIJ Health System, Manhasset, NY (A.E.).
J Am Heart Assoc. 2014 Nov 17;3(6):e001152. doi: 10.1161/JAHA.114.001152.
Hospitalized medical patients are at risk for venous thromboembolism (VTE). Universal application of pharmacological thromboprophylaxis has the potential to place a large number of patients at increased bleeding risk. In this study, we aimed to externally validate the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) VTE risk assessment model in a hospitalized general medical population.
We identified medical discharges that met the IMPROVE protocol. Cases were defined as hospital-acquired VTE and confirmed by diagnostic study within 90 days of index hospitalization; matched controls were also identified. Risk factors for VTE were based on the IMPROVE risk assessment model (aged >60 years, prior VTE, intensive care unit or coronary care unit stay, lower limb paralysis, immobility, known thrombophilia, and cancer) and were measured and assessed. A total of 19 217 patients met the inclusion criteria. The overall VTE event rate was 0.7%. The IMPROVE risk assessment model identified 2 groups of the cohort by VTE incidence rate: The low-risk group had a VTE event rate of 0.42 (95% CI 0.31 to 0.53), corresponding to a score of 0 to 2, and the at-risk group had a VTE event rate of 1.29 (95% CI 1.01 to 1.57), corresponding to a score of ≥3. Low-risk status for VTE encompassed 68% of the patient cohort. The area under the receiver operating characteristic curve was 0.702, which was in line with the derivation cohort findings.
The IMPROVE VTE risk assessment model validation cohort revealed good discrimination and calibration for both the overall VTE risk model and the identification of low-risk and at-risk medical patient groups, using a risk score of ≥3. More than two thirds of the entire cohort had a score ≤2.
住院内科患者存在静脉血栓栓塞（VTE）风险。普遍应用药物性血栓预防措施可能会使大量患者出血风险增加。在本研究中，我们旨在对住院普通内科人群的国际静脉血栓栓塞症医学预防登记（IMPROVE）VTE风险评估模型进行外部验证。
我们确定了符合IMPROVE方案的内科出院病例。病例定义为医院获得性VTE，并在索引住院90天内通过诊断研究确诊；同时也确定了匹配的对照。VTE的风险因素基于IMPROVE风险评估模型（年龄>60岁、既往VTE、入住重症监护病房或冠心病监护病房、下肢瘫痪、活动受限、已知血栓形成倾向和癌症），并进行了测量和评估。共有19217例患者符合纳入标准。总体VTE事件发生率为0.7%。IMPROVE风险评估模型根据VTE发生率将队列分为两组：低风险组VTE事件发生率为0.42（95%CI 0.31至0.53），对应评分为0至2分；高危组VTE事件发生率为1.29（95%CI 1.01至1.57），对应评分≥3分。VTE低风险状态涵盖68%的患者队列。受试者工作特征曲线下面积为0.702，与推导队列的结果一致。
IMPROVE VTE风险评估模型验证队列显示，对于总体VTE风险模型以及识别低风险和高危内科患者组，使用≥3分的风险评分具有良好的区分度和校准度。超过三分之二的整个队列评分≤2分。
