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Acute Medical Illness: Advanced Age Alone Predicts Venous Thromboembolism Similar to Existing Risk Assessment Models

Advanced age alone might be an alternative to complex models in predicting venous thromboembolism among medical inpatients.

Takeaway

  • Padua, Caprini and International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) risk assessment models (RAMs) had poor discriminating ability to predict venous thromboembolism (VTE) in acutely ill medical inpatients.

  • Findings from this secondary analysis of PREVENU study suggest that none of these RAMs provided a better prediction than advanced age alone.
  • Using an age above 70 years might be the easiest and most practical way of identifying medical inpatients requiring thromboprophylaxis.

Why This Matters

  • International consensus is lacking on criteria for thromboprophylaxis in medical inpatients.

  • A strategy based on age alone is easily implementable in regular clinical practice.

Study Design

  • This retrospective study included 14,910 patients (median age, 73 years) from Prevenu trial who were hospitalised for acute medical illnesses in a medical ward for at least 2 days.

  • Critically ill patients were excluded.
  • The primary aim was to assess the global discriminatory power of the RAMs in predicting VTE in comparison with advanced age alone.
  • The secondary aim was to compare the incidence of VTE between low- and high-risk patients and assess the robustness of primary results.
  • Patients with a Padua score ≥4, Caprini score ≥3, IMPROVE score ≥2 (intermediate and high risk) and IMPROVE score ≥4 (high risk) were considered at an increased risk for VTE.
  • Advanced age was defined as reaching 70 years, as defined in the Padua score.
  • Funding: None.

Key Results

  • Overall, 1.8% of patients experienced symptomatic VTE during follow-up.

  • The median time until VTE occurrence was 22 (interquartile range, 10-46) days.
  • The area under curve (AUC) of predicting VTE was 0.61 (95% CI, 0.58-0.64) for advanced age alone.
  • None of the 3 RAMs had a significantly different AUC compared with advanced age alone for predicting VTE (P=0.284):
    • Padua: 0.64 (95% CI, 0.61-0.67);
    • IMPROVE: 0.63 (95% CI, 0.60-0.66); and
    • Caprini: 0.60 (95% CI, 0.57-0.63).
  • In low-risk patients, VTE incidence was 0.6%, 0.5%, 1.0%, 1.6% and 1.2%, according to Padua, Caprini, IMPROVE intermediate-high score, IMPROVE high score and advanced age, respectively.
  • In high-risk patients, VTE incidence was 2.2%, 1.9%, 2.5%, 3.0% and 2.3% according to Padua, Caprini, IMPROVE intermediate-high score, IMPROVE high score and advanced age, respectively.
  • Global performances were poor for 3 RAMs and advanced age (Youden Index for all, <0.25%).
  • After excluding patients who received anticoagulant prophylaxis during their hospital stay, the AUC of predicting VTE was 0.66 (95% CI, 0.62-0.70) for advanced age and not significantly different for the RAMs (P=0.266).

Reference

  1. Moumneh T, Riou J, Douillet D, Henni S, Mottier D, Tritschler T, Le Gal G, Roy PM. Validation of risk assessment models predicting venous thromboembolism in acutely ill medical inpatients: A cohort study. J Thromb Haemost. 2020;18(6):1398-1407. doi: 10.1111/jth.14796. PMID: 32168402
MAT-BH-2300402/v1/Jun 2023