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Thromb Haemost 2014; 112(04): 692-699
DOI: 10.1160/TH14-03-0239
Blood Coagulation, Fibrinolysis and Cellular Haemostasis
Schattauer GmbH

External validation of a risk assessment model for venous thromboembolism in the hospitalised acutely-ill medical patient (VTE-VALOURR)

Charles E. Mahan
1   Presbyterian Healthcare Services, University of New Mexico, Albuquerque, New Mexico, USA
,
Yang Liu
2   McMaster Transfusion Research Program, McMaster University, Hamilton, Ontario, Canada
,
A. Graham Turpie
3   Department of Medicine, McMaster University, Hamilton, Ontario, Canada
,
Jennifer T. Vu
4   Texas Children’s Hospital, Houston, Texas, USA
,
Nancy Heddle
2   McMaster Transfusion Research Program, McMaster University, Hamilton, Ontario, Canada
,
Richard J. Cook
5   Professor of Statistical Methods for Health Research, University of Waterloo, Waterloo, Ontario, Canada
,
Undaleeb Dairkee
6   Department of Medicine, McMaster University, Hamilton, Ontario, Canada
,
Alex C. Spyropoulos
7   Anticoagulation Services and Clinical Thrombosis, North Shore-LIJ Health System at Lenox Hill Hospital, Hofstra North Shore-LIJ School of Medicine, Manhasset, New York, USA
› Author Affiliations Financial support: The study was funded in part by a traveling fellowship grant from North American Thrombosis Forum for Dr. Mahan. In addition, McMaster University funded partial research assistant resources.
Further Information

Publication History

Received: 17 March 2014

Accepted after major revision: 30 April 2014

Publication Date:
04 December 2017 (online)

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Summary

Venous thromboembolic (VTE) risk assessment remains an important issue in hospitalised, acutely-ill medical patients, and several VTE risk assessment models (RAM) have been proposed. The purpose of this large retrospective cohort study was to externally validate the IMPROVE RAM using a large database of three acute care hospitals. We studied 41,486 hospitalisations (28,744 unique patients) with 1,240 VTE hospitalisations (1,135 unique patients) in the VTE cohort and 40,246 VTE-free hospitalisations (27,609 unique patients) in the control cohort. After chart review, 139 unique VTE patients were identified and 278 randomly-selected matched patients in the control cohort. Seven independent VTE risk factors as part of the RAM in the derivation cohort were identified. In the validation cohort, the incidence of VTE was 0.20%; 95% confidence interval (CI) 0.18–0.22, 1.04%; 95%CI 0.88–1.25, and 4.15%; 95%CI 2.79–8.12 in the low, moderate, and high VTE risk groups, respectively, which compared to rates of 0.45%, 1.3%, and 4.74% in the three risk categories of the derivation cohort. For the derivation and validation cohorts, the total percentage of patients in low, moderate and high VTE risk occurred in 68.6% vs 63.3%, 24.8% vs 31.1%, and 6.5% vs 5.5%, respectively. Overall, the area under the receiver-operator characteristics curve for the validation cohort was 0.7731. In conclusion, the IMPROVE RAM can accurately identify medical patients at low, moderate, and high VTE risk. This will tailor future thromboprophylactic strategies in this population as well as identify particularly high VTE risk patients in whom multimodal or more intensive prophylaxis may be beneficial.

Keywords

Venous thromboembolism risk assessment - prevention - risk assessment models - hospitalised medical patients - validation

 

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