Halloran Thomas P O, Bassa Bibi Ayesha, Nemeth Banne, Cannegieter Suzanne, Breslin Tomas, Wakai Abel, O'Driscoll Julie, O'Rourke Sean, O'Connell Niamh, Áinle Fionnuala Ní, Watts Michael, Keeffe Denis O
University Hospital Limerick, Limerick, Ireland; University of Limerick, Limerick, Ireland.
Mater Misericordiae University Hospital, Dublin, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland.
J Thromb Haemost. 2025 Mar;23(3):947-956. doi: 10.1016/j.jtha.2024.11.010. Epub 2024 Nov 29.
Patients requiring lower limb immobilization after injury have an increased venous thromboembolism (VTE) risk. The extent of this risk in published studies varies. The Thrombosis Risk Prediction for Patients with Cast Immobilization (TRiP[cast]) model quantifies VTE risk using clinical parameters. Delineating low-risk from high-risk patients remains challenging.
Determine the 90-day incidence of symptomatic VTE following temporary lower limb immobilization after injury in an unselected cohort. Prospectively collect data on risk factors, including those incorporated in the TRiP(cast) model, to calculate TRiP(cast) scores.
TILLIRI is a multicenter, pragmatic, observational cohort study including 10 sites within the Irish Network for VTE Research. Patients aged ≥18 years with an immobilized injured lower limb were included. Twenty-one clinical variables were collected at presentation. Thromboprophylaxis was prescribed according to clinical gestalt. Patients were followed up at 90 days to determine if VTE occurred.
Between November 2018 and February 2023, 1242 patients were recruited. Follow-up was complete for 1199 patients (96.5%). Forty-three patients (3.5%) were lost to follow-up. Forty-four (3.6%) patients and 125 (10%) patients were prescribed anticoagulation and aspirin, respectively. Twenty-one patients receiving regular anticoagulation were removed from the final analysis. VTE incidence at 90-day follow-up was 6/1179 (0.51%; 95% CI, 0.1%-0.92%). TRiP(cast) scores were calculated for 1176/1221 patients. A total of 846 patients (71.9%) had a TRiP(cast) score < 7, received no prophylaxis, and had no VTE.
TILLIRI indicates a low VTE incidence in an unselected cohort following lower limb immobilization with low rates of prophylaxis use. The proportion of patients with low TRiP(cast) scores and no symptomatic VTE suggests that thromboprophylaxis may be avoided in patients with TRiP(cast) scores < 7 with a low 90-day VTE risk.
受伤后需要下肢固定的患者静脉血栓栓塞（VTE）风险增加。已发表研究中该风险的程度各不相同。石膏固定患者血栓形成风险预测（TRiP[石膏]）模型使用临床参数对VTE风险进行量化。区分低风险和高风险患者仍然具有挑战性。
确定在一个未经过筛选的队列中，受伤后临时下肢固定后90天内有症状VTE的发生率。前瞻性收集风险因素数据，包括TRiP（石膏）模型中纳入的因素，以计算TRiP（石膏）评分。
TILLIRI是一项多中心、务实的观察性队列研究，包括爱尔兰VTE研究网络内的10个地点。纳入年龄≥18岁且下肢受伤并固定的患者。就诊时收集21项临床变量。根据临床经验开具血栓预防药物。对患者进行90天随访，以确定是否发生VTE。
2018年11月至2023年2月期间，招募了1242例患者。1199例患者（96.5%）完成随访。43例患者（3.5%）失访。分别有44例（3.6%）和125例（10%）患者接受了抗凝治疗和阿司匹林治疗。21例接受常规抗凝治疗的患者被排除在最终分析之外。90天随访时VTE发生率为6/1179（0.51%；95%CI，0.1%-0.92%）。为1176/1221例患者计算了TRiP（石膏）评分。共有846例患者（71.9%）的TRiP（石膏）评分<7，未接受预防治疗且未发生VTE。
TILLIRI表明，在一个未经过筛选的队列中，下肢固定后VTE发生率较低，预防药物使用率也较低。TRiP（石膏）评分低且无有症状VTE的患者比例表明，对于90天VTE风险低且TRiP（石膏）评分<7的患者，可能无需进行血栓预防。
