Tikkinen Kari A O, Siegal Deborah M, Devereaux P J, Tornberg Sara V, Borges Flavia K, Ofori Sandra, Pinthus Jehonathan, Shayegan Bobby, Lavikainen Lauri I, Guyatt Gordon H, Roshanov Pavel S
Department of Surgery, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Blood Adv. 2025 Aug 12;9(15):3837-3844. doi: 10.1182/bloodadvances.2024015515.
Venous thromboembolism (VTE) remains a major postoperative risk. Systematic reviews have established procedure-specific VTE risk estimates, which form 1 component of the CLUE postsurgery VTE risk instrument. The instrument also incorporates patient-level factors, including age (≥75 years), body mass index (≥35 kg/m2), and prior VTE, to stratify overall risk. However, the patient risk factor component has not been formally validated. Therefore, we conducted the validation using data from the VISION study, a prospective, international cohort of 11 636 patients undergoing major general abdominal, urologic, or gynecologic surgery. Thirty-day postoperative VTE incidence was analyzed using modified Poisson regression. The instrument classified patients into low- (72%), medium- (25%), and high-risk (4%) categories. VTE occurred in 97 patients (0.8%). Compared to the low-risk group, the relative risk of VTE was 1.56 (95% confidence interval [CI], 1.01-2.43) for medium-risk patients and 3.60 (95% CI, 1.90-6.83) for high-risk patients. Among patients who did not receive antithrombotic medication, relative risks increased to 1.91 for medium-risk patients and 5.41 for high-risk patients. The CLUE postsurgery VTE risk instrument, using 3 widely available patient-level factors, accurately classifies patients into substantially different categories of relative VTE risk. This validated patient component complements procedure-specific absolute risk estimates derived from prior systematic reviews. To support evidence-based thromboprophylaxis decisions, the instrument is now available through an interactive online platform (www.cluevte.org).
静脉血栓栓塞症（VTE）仍然是术后的主要风险。系统评价已经确定了特定手术的VTE风险估计值，这是CLUE术后VTE风险评估工具的一个组成部分。该工具还纳入了患者层面的因素，包括年龄（≥75岁）、体重指数（≥35kg/m²）和既往VTE，以分层总体风险。然而，患者风险因素部分尚未经过正式验证。因此，我们使用VISION研究的数据进行了验证，这是一项针对11636例接受大型普通腹部、泌尿外科或妇科手术的患者的前瞻性国际队列研究。使用修正泊松回归分析术后30天的VTE发生率。该工具将患者分为低风险（72%）、中风险（25%）和高风险（4%）类别。97例患者（0.8%）发生了VTE。与低风险组相比，中风险患者VTE的相对风险为1.56（95%置信区间[CI]，1.01-2.43），高风险患者为3.60（95%CI，1.90-6.83）。在未接受抗血栓药物治疗的患者中，中风险患者的相对风险增加到1.91，高风险患者增加到5.41。CLUE术后VTE风险评估工具利用3个广泛可用的患者层面因素，准确地将患者分为相对VTE风险差异很大的类别。这个经过验证的患者部分补充了先前系统评价得出的特定手术绝对风险估计值。为了支持基于证据的血栓预防决策，现在可以通过一个交互式在线平台（www.cluevte.org）使用该工具。
