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Original Research: PULMONARY VASCULAR DISEASE |

Predictive and Associative Models to Identify Hospitalized Medical Patients at Risk for VTEPredictive Model to Identify Risk for VTE

Alex C. Spyropoulos, MD, FCCP; Frederick A. Anderson, Jr, PhD; Gordon FitzGerald, PhD; Herve Decousus, MD; Mario Pini, MD; Beng H. Chong, MD, PhD; Rainer B. Zotz, MD; Jean-François Bergmann, MD; Victor Tapson, MD, FCCP; James B. Froehlich, MD, MPH; Manuel Monreal, MD; Geno J. Merli, MD; Ricardo Pavanello, MD; Alexander G. G. Turpie, MD; Mashio Nakamura, MD; Franco Piovella, MD; Ajay K. Kakkar, MBBS, PhD; Frederick A. Spencer, MD; for the IMPROVE Investigators
Author and Funding Information

From the Hamilton Health Sciences General Hospital (Drs Spyropoulos and Turpie), McMaster University, and Hamilton Health Sciences (Dr Spencer), McMaster University, Hamilton, ON, Canada; Center for Outcomes Research (Drs Anderson and FitzGerald), University of Massachusetts Medical School, Worcester, MA; INSERM, CIE3, Saint-Etienne (Dr Decousus), University Saint-Etienne, and CHU Saint-Etienne, Hôpital Nord, Service de Médecine Interne et Thérapeutique, Saint-Etienne, France; Medicina Interna II (Dr Pini), Fidenza Hospital, Parma, Italy; St. George Clinical School (Dr. Chong), University of New South Wales, Sydney, NSW, Australia; Hämostase-Institut Düsseldorf (Dr Zotz), Düsseldorf, Germany; Hôpital Lariboisiere Clinique Thérapeutique (Dr Bergmann), University Paris Diderot, Paris, France; Duke University Medical Center (Dr Tapson), Durham, NC; Vascular Medicine (Dr Froehlich), University of Michigan Health System, Ann Arbor, MI; Servicio de Medicina Interna (Dr Monreal), Hospital Germans Trias i Pujol, Badalona, Spain; Jefferson Vascular Diseases Center (Dr Merli), Departments of Surgery and Medicine, Thomas Jefferson University Hospital, Philadelphia, PA; Hospital do Coracao Clinica Medica São Paulo (Dr Pavanello), São Paulo, Brazil; Department of Cardiology (Dr Nakamura), Mie University Graduate School of Medicine, Tsu Mie, Japan; U.O. Angiologia (Dr Piovella), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; and Thrombosis Research Institute and University College London (Dr Kakkar), London, England.

Correspondence to: Alex C. Spyropoulos, MD, FCCP, McMaster University, Hamilton General Hospital, Thrombosis Unit, 6th Floor, McMaster Clinic, 237 Barton St E, Hamilton, ON, L8L 2X2, Canada; e-mail: spyropa@mcmaster.ca


Funding/Support: The IMPROVE study was supported by a grant from Sanofi-Aventis to the Center for Outcomes Research at the University of Massachusetts Medical School.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;140(3):706-714. doi:10.1378/chest.10-1944
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Background:  Acutely ill hospitalized medical patients are at risk for VTE. We assessed the incidence of VTE in the observational International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) study and derived VTE risk assessment scores at admission and associative VTE scores during hospitalization.

Methods:  Data from 15,156 medical patients were analyzed to determine the cumulative incidence of clinically observed VTE over 3 months after admission. Multiple regression analysis identified factors associated with VTE risk.

Results:  Of the 184 patients who developed symptomatic VTE, 76 had pulmonary embolism, and 67 had lower-extremity DVT. Cumulative VTE incidence was 1.0%; 45% of events occurred after discharge. Factors independently associated with VTE were previous VTE, known thrombophilia, cancer, age > 60 years, lower-limb paralysis, immobilization ≥ 7 days, and admission to an ICU or coronary care unit (first four were available at admission). Points were assigned to each factor identified to give a total risk score for each patient. At admission, 67% of patients had a score ≥ 1. During hospitalization, 31% had a score ≥ 2; for a score of 2 or 3, observed VTE risk was 1.5% vs 5.7% for a score ≥ 4. Observed and predicted rates were similar for both models (C statistic, 0.65 and 0.69, respectively). During hospitalization, a score ≥ 2 was associated with higher overall and VTE-related mortality.

Conclusions:  Weighted VTE risk scores derived from four clinical risk factors at hospital admission can predict VTE risk in acutely ill hospitalized medical patients. Scores derived from seven clinical factors during hospitalization may help us to further understand symptomatic VTE risk. These scores require external validation.

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