Semin Thromb Hemost
DOI: 10.1055/s-0037-1604086
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Modified Ottawa Score and Clinical Events in Hospitalized Patients with Cancer-Associated Thrombosis from the Swiss VTE Registry

Adriano Alatri1, Lucia Mazzolai1, Nils Kucher2, Drahomir Aujesky3, Jürg H. Beer4, Thomas Baldi5, Martin Banyai6, Daniel Hayoz7, Thomas Kaeslin8, Wolfgang Korte9, Robert Escher10, Marc Husmann11, Beat Frauchiger12, Rolf P. Engelberger2, 7, Iris Baumgartner2, David Spirk13
  • 1Division of Angiology, Lausanne University Hospital, Lausanne, Switzerland
  • 2Division of Vascular Medicine, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland
  • 3Division of General Internal Medicine, Bern University Hospital, Bern, Switzerland
  • 4Department of Internal Medicine, Cantonal Hospital Baden, Baden, Switzerland
  • 5Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
  • 6Department of Internal Medicine, Cantonal Hospital Lucerne, Lucerne, Switzerland
  • 7Department of Internal Medicine, Cantonal Hospital Fribourg, Fribourg, Switzerland
  • 8Department of Internal Medicine, Cantonal Hospital Obwalden, Sarnen, Switzerland
  • 9Department of Internal Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
  • 10Department of Internal Medicine, Regional Hospital Burgdorf, Burgdorf, Switzerland
  • 11Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
  • 12Department of Internal Medicine, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland
  • 13Institute of Pharmacology, University of Bern, Bern, Switzerland
Further Information

Publication History

Publication Date:
04 August 2017 (eFirst)

Abstract

The modified Ottawa score (MOS) predicted venous thromboembolism (VTE) recurrence in a cohort of patients with cancer-associated thrombosis mainly managed on an outpatient basis. We aimed to assess the prognostic value of the MOS in hospitalized patients with cancer-associated thrombosis. In 383 hospitalized patients with cancer-associated VTE from the SWIss VTE Registry, 98 (25%) were classified as low risk, 175 (46%) as intermediate risk, and 110 (29%) as high risk for VTE recurrence based on the MOS. Clinical end points were recurrent VTE, fatal VTE, major bleeding, and overall mortality at 90 days. Overall, 179 (47%) patients were female, 172 (45%) had metastatic disease, and 72 (19%) prior VTE. The primary site of cancer was lung in 48 (13%) patients and breast in 43 (11%). According to the MOS, the rate of VTE recurrence was 4.1% for low, 6.3% intermediate, and 5.5% high risk (p = 0.75); the rate of fatal VTE was 0.8, 1.9, and 2.0% (p = 0.69); the rate of major bleeding was 3.1, 4.1, and 3.6% (p = 0.92); and the rate of death was 6.1, 12.0, and 28.2% (p < 0.001), respectively. None of the MOS items was associated with VTE recurrence: female gender hazard ratio (HR) 1.26 (95% confidence interval [CI], 0.53–2.96), lung cancer HR 1.17 (95% CI, 0.35–3.98), prior VTE HR 0.44 (95% CI, 0.10–1.91), breast cancer HR 0.83 (95% CI, 0.19–3.58), and absence of metastases HR 0.74 (95% CI, 0.31–1.74). In hospitalized patients with cancer-associated VTE, the MOS failed to predict VTE recurrence at 3 months but was associated with early mortality.