Semin Thromb Hemost 2017; 43(05): 460-468
DOI: 10.1055/s-0036-1597901
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Scoring Systems for Estimating Risk of Venous Thromboembolism in Hospitalized Medical Patients

Sofia Barbar
1   Department of Medicine, “Azienda Ulss 15 Alta Padovana,” Cittadella, Padova, Italy
,
Paolo Prandoni
2   Department of Cardiovascular Sciences, University of Padova, Padova, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
06 February 2017 (online)

Abstract

Deep vein thrombosis and pulmonary embolism are associated with considerable morbidity and mortality in hospitalized patients, accounting for up to 10% of hospitalization-related deaths in both surgical and medical patients. Pharmacologic thromboprophylaxis has been demonstrated to be effective, safe, and cost-effective in preventing hospital-acquired venous thromboembolism (VTE) among medical inpatients, and clinician awareness of thrombotic risk promotes prescription of thromboprophylaxis. Guidelines recommend stratification of thrombotic risk for all patients and, unless contraindicated, administration of VTE prophylaxis. Based on several recognized predisposing and exposing risk factors for VTE, several scoring systems have been published in the past 15 years. Borrowing models developed in the surgical setting, recognized risk factors for VTE complications in medical inpatients have been combined in different weighted scores and derived and validated in heterogeneous medical populations. Although the perfect score, balancing thrombotic and hemorrhagic risk, has probably not yet been built, the adoption of an easy-to-use risk assessment model has the potential to support physicians in properly stratifying VTE risk in medical inpatients, tailoring thromboprophylaxis prescription.

 
  • References

  • 1 Geerts WH, Bergqvist D, Pineo GF. , et al. American College of Chest Physicians. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133: 381S-453S
  • 2 Heit JA, Melton III LJ, Lohse CM. , et al. Incidence of venous thromboembolism in hospitalized patients vs community residents. Mayo Clin Proc 2001; 76 (11) 1102-1110
  • 3 Cohen AT, Alikhan R, Arcelus JI. , et al. Assessment of venous thromboembolism risk and the benefits of thromboprophylaxis in medical patients. Thromb Haemost 2005; 94 (04) 750-759
  • 4 Piazza G, Seddighzadeh A, Goldhaber SZ. Double trouble for 2,609 hospitalized medical patients who developed deep vein thrombosis: prophylaxis omitted more often and pulmonary embolism more frequent. Chest 2007; 132 (02) 554-561
  • 5 Cohen AT, Tapson VF, Bergmann JF. , et al; ENDORSE Investigators. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet 2008; 371 (9610): 387-394
  • 6 Sandler DA, Martin JF. Autopsy proven pulmonary embolism in hospital patients: are we detecting enough deep vein thrombosis?. J R Soc Med 1989; 82 (04) 203-205
  • 7 Goldhaber SZ, Dunn K, MacDougall RC. New onset of venous thromboembolism among hospitalized patients at Brigham and Women's Hospital is caused more often by prophylaxis failure than by withholding treatment. Chest 2000; 118 (06) 1680-1684
  • 8 Leizorovicz A, Cohen AT, Turpie AG, Olsson CG, Vaitkus PT, Goldhaber SZ. ; PREVENT Medical Thromboprophylaxis Study Group. Randomized, placebo-controlled trial of dalteparin for the prevention of venous thromboembolism in acutely ill medical patients. Circulation 2004; 110 (07) 874-879
  • 9 Samama MM, Cohen AT, Darmon JY. , et al; Prophylaxis in Medical Patients with Enoxaparin Study Group. A comparison of enoxaparin with placebo for the prevention of venous thromboembolism in acutely ill medical patients. N Engl J Med 1999; 341 (11) 793-800
  • 10 Cohen AT, Davidson BL, Gallus AS. , et al; ARTEMIS Investigators. Efficacy and safety of fondaparinux for the prevention of venous thromboembolism in older acute medical patients: randomised placebo controlled trial. BMJ 2006; 332 (7537): 325-329
  • 11 Weill-Engerer S, Meaume S, Lahlou A. , et al. Risk factors for deep vein thrombosis in inpatients aged 65 and older: a case-control multicenter study. J Am Geriatr Soc 2004; 52 (08) 1299-1304
  • 12 Gussoni G, Campanini M, Silingardi M. , et al. In-hospital symptomatic venous thromboembolism and antithrombotic prophylaxis in Internal Medicine. Thromb Haemost 2009; 101 (05) 839-901
  • 13 Maynard GA, Morris TA, Jenkins IH. , et al. Optimizing prevention of hospital-acquired venous thromboembolism (VTE): prospective validation of a VTE risk assessment model. J Hosp Med 2010; 5 (01) 10-18
  • 14 Lloyd NS, Douketis JD, Moinuddin I, Lim W, Crowther MA. Anticoagulant prophylaxis to prevent asymptomatic deep vein thrombosis in hospitalized medical patients: a systematic review and meta-analysis. J Thromb Haemost 2008; 6 (03) 405-414
  • 15 Kahn SR, Lim W, Dunn AS. , et al. Prevention of VTE in Nonsurgical patients. Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141: e195S-e226S
  • 16 Goldhaber SZ, Tapson VF. ; DVT FREE Steering Committee. A prospective registry of 5,451 patients with ultrasound-confirmed deep vein thrombosis. Am J Cardiol 2004; 93 (02) 259-262
  • 17 Wiseman DN, Harrison J. A retrospective review of the use of thromboprophylaxis in patients who subsequently developed a venous thromboembolism after discharge from hospital. N Z Med J 2010; 123 (1309): 37-49
  • 18 Decousus H, Tapson VF, Bergmann JF. , et al; IMPROVE Investigators. Factors at admission associated with bleeding risk in medical patients: findings from the IMPROVE investigators. Chest 2011; 139 (01) 69-79
  • 19 Thromboembolic Risk Factors (THRIFT) Consensus Group. Risk of and prophylaxis for venous thromboembolism in hospital patients. BMJ 1992; 305 (6853): 567-574
  • 20 Caprini JA, Arcelus JI, Hasty JH, Tamhane AC, Fabrega F. Clinical assessment of venous thromboembolic risk in surgical patients. Semin Thromb Hemost 1991; 17 (Suppl. 03) 304-312
  • 21 Arcelus JI, Candocia S, Traverso CI, Fabrega F, Caprini JA, Hasty JH. Venous thromboembolism prophylaxis and risk assessment in medical patients. Semin Thromb Hemost 1991; 17 (Suppl. 03) 313-318
  • 22 Lutz L, Haas S, Hach-Wunderle V. , et al. Venous thromboembolism in internal medicine: risk assessment and pharmaceutical prophylaxis. DieMed Welt 2002; 53: 231-234
  • 23 Samama MM, Dahl OE, Mismetti P. , et al. An electronic tool for venous thromboembolism prevention in medical and surgical patients. Haematologica 2006; 91 (01) 64-70
  • 24 Rothberg MB, Lindenauer PK, Lahti M, Pekow PS, Selker HP. Risk factor model to predict venous thromboembolism in hospitalized medical patients. J Hosp Med 2011; 6 (04) 202-209
  • 25 Kucher N, Koo S, Quiroz R. , et al. Electronic alerts to prevent venous thromboembolism among hospitalized patients. N Engl J Med 2005; 352 (10) 969-977
  • 26 Chopard P, Spirk D, Bounameaux H. Identifying acutely ill medical patients requiring thromboprophylaxis. J Thromb Haemost 2006; 4 (04) 915-916
  • 27 Chopard P, Dörffler-Melly J, Hess U. , et al. Venous thromboembolism prophylaxis in acutely ill medical patients: definite need for improvement. J Intern Med 2005; 257 (04) 352-357
  • 28 Geerts WH, Pineo GF, Heit JA. , et al. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004; 126 (3, Suppl): 338S-400S
  • 29 Barbar S, Noventa F, Rossetto V. , et al. A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: the Padua Prediction Score. J Thromb Haemost 2010; 8 (11) 2450-2457
  • 30 Rossetto V, Barbar S, Vedovetto V, Milan M, Prandoni P. Physicians' compliance with the Padua Prediction Score for preventing venous thromboembolism among hospitalized medical patients. J Thromb Haemost 2013; 11 (07) 1428-1430
  • 31 Nendaz M, Spirk D, Kucher N. , et al. Multicentre validation of the Geneva Risk Score for hospitalised medical patients at risk of venous thromboembolism. Explicit ASsessment of Thromboembolic RIsk and Prophylaxis for Medical PATients in SwitzErland (ESTIMATE). Thromb Haemost 2014; 111 (03) 531-538
  • 32 Tapson VF, Decousus H, Pini M. , et al; IMPROVE Investigators. Venous thromboembolism prophylaxis in acutely ill hospitalized medical patients: findings from the International Medical Prevention Registry on Venous Thromboembolism. Chest 2007; 132 (03) 936-945
  • 33 Spyropoulos AC, Anderson Jr FA, Fitzgerald G. , et al; IMPROVE Investigators. Predictive and associative models to identify hospitalized medical patients at risk for VTE. Chest 2011; 140 (03) 706-714
  • 34 Mahan CE, Liu Y, Turpie AG. , et al. External validation of a risk assessment model for venous thromboembolism in the hospitalised acutely-ill medical patient (VTE-VALOURR). Thromb Haemost 2014; 112 (04) 692-699
  • 35 Hostler DC, Marx ES, Moores LK. , et al. Validation of the IMPROVE Bleeding Risk Score. Chest 2016; 149 (02) 372-379
  • 36 Woller SC, Stevens SM, Jones JP. , et al. Derivation and validation of a simple model to identify venous thromboembolism risk in medical patients. Am J Med 2011; 124 (10) 947-954.e2
  • 37 Zakai NA, Callas PW, Repp AB, Cushman M. Venous thrombosis risk assessment in medical inpatients: the medical inpatients and thrombosis (MITH) study. J Thromb Haemost 2013; 11 (04) 634-641
  • 38 Grant PJ, Greene MT, Chopra V, Bernstein SJ, Hofer TP, Flanders SA. Assessing the Caprini score for risk assessment of venous thromboembolism in hospitalized medical patients. Am J Med 2016; 129 (05) 528-535
  • 39 Greene MT, Spyropoulos AC, Chopra V. , et al. Validation of risk assessment models of venous thromboembolism in hospitalized medical patients. Am J Med 2016; 129 (09) 1001.e9-1001.e18
  • 40 La Regina M, Orlandini F, Marchini F. , et al. Combined assessment of thrombotic and haemorrhagic risk in acute medical patients. Thromb Haemost 2016; 115 (02) 392-398
  • 41 Gussoni G, Foglia E, Frasson S. , et al; FADOI Permanent Study Group on Clinical Governance. Real-world economic burden of venous thromboembolism and antithrombotic prophylaxis in medical inpatients. Thromb Res 2013; 131 (01) 17-23
  • 42 Ageno W, Dentali F. Prevention of in-hospital VTE: why can't we do better?. Lancet 2008; 371 (9610): 361-362
  • 43 Huang W, Anderson FA, Spencer FA, Gallus A, Goldberg RJ. Risk-assessment models for predicting venous thromboembolism among hospitalized non-surgical patients: a systematic review. J Thromb Thrombolysis 2013; 35 (01) 67-80
  • 44 Alikhan R, Cohen AT, Combe S. , et al; MEDENOX Study. Risk factors for venous thromboembolism in hospitalized patients with acute medical illness: analysis of the MEDENOX Study. Arch Intern Med 2004; 164 (09) 963-968
  • 45 Zakai NA, Wright J, Cushman M. Risk factors for venous thrombosis in medical inpatients: validation of a thrombosis risk score. J Thromb Haemost 2004; 2 (12) 2156-2161
  • 46 Ocak G, Vossen CY, Verduijn M. , et al. Risk of venous thrombosis in patients with major illnesses: results from the MEGA study. J Thromb Haemost 2013; 11 (01) 116-123
  • 47 Kamphuisen PW, Agnelli G, Sebastianelli M. Prevention of venous thromboembolism after acute ischemic stroke. J Thromb Haemost 2005; 3 (06) 1187-1194