Multicentre validation of the Geneva Risk Score for hospitalised medical patients at risk of venous thromboembolism

Mathieu Nendaz; David Spirk; Nils Kucher; Drahomir Aujesky; Daniel Hayoz; Jürg H. Beer; Marc Husmann; Beat Frauchiger; Wolfgang Korte; Walter A. Wuillemin; Kurt Jäger; Marc Righini; Henri Bounameaux

doi:10.1160/TH13-05-0427

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2014; 111(03): 531-538
DOI: 10.1160/TH13-05-0427

New Technologies, Diagnostic Tools and Drugs

Schattauer GmbH

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)

Mathieu Nendaz^*

¹Department of Internal Medicine, University Hospitals Geneva, Switzerland

,

David Spirk^*

²Medical Department, Sanofi-Aventis (Suisse) SA, Vernier, Switzerland

,

Nils Kucher

³Swiss Cardiovascular Center, University Hospital Bern, Switzerland

,

Drahomir Aujesky

⁴Division of General Internal Medicine, University Hospital Bern, Switzerland

,

Daniel Hayoz

⁵Department of Internal Medicine, Cantonal Hospital Fribourg, Switzerland

,

Jürg H. Beer

⁶Department of Internal Medicine, Cantonal Hospital Baden, Switzerland

,

Marc Husmann

⁷Clinic of Angiology, University Hospital Zurich, Switzerland

,

Beat Frauchiger

⁸Department of Internal Medicine, Cantonal Hospital Frauenfeld, Switzerland

,

Wolfgang Korte

⁹Department of Internal Medicine, Cantonal Hospital St. Gallen, Switzerland

,

Walter A. Wuillemin

¹⁰Division of Hematology and Central Hematology Laboratory, Cantonal Hospital Lucerne and University of Bern, Switzerland

,

Kurt Jäger

²Medical Department, Sanofi-Aventis (Suisse) SA, Vernier, Switzerland

,

Marc Righini

¹Department of Internal Medicine, University Hospitals Geneva, Switzerland

,

Henri Bounameaux

¹Department of Internal Medicine, University Hospitals Geneva, Switzerland

› Author Affiliations

Abstract

Summary

There is a need to validate risk assessment tools for hospitalised medical patients at risk of venous thromboembolism (VTE). We investigated whether a predefined cut-off of the Geneva Risk Score, as compared to the Padua Prediction Score, accurately distinguishes low-risk from high-risk patients regardless of the use of thromboprophylaxis. In the multicentre, prospective Explicit ASsessment of Thromboembolic RIsk and Prophylaxis for Medical PATients in SwitzErland (ESTIMATE) cohort study, 1,478 hospitalised medical patients were enrolled of whom 637 (43%) did not receive thromboprophylaxis. The primary endpoint was symptomatic VTE or VTE-related death at 90 days. The study is registered at ClinicalTrials.gov, number NCT01277536. According to the Geneva Risk Score, the cumulative rate of the primary endpoint was 3.2% (95% confidence interval [CI] 2.2–4.6%) in 962 high-risk vs 0.6% (95% CI 0.2–1.9%) in 516 low-risk patients (p=0.002); among patients without prophylaxis, this rate was 3.5% vs 0.8% (p=0.029), respectively. In comparison, the Padua Prediction Score yielded a cumulative rate of the primary endpoint of 3.5% (95% CI 2.3–5.3%) in 714 high-risk vs 1.1% (95% CI 0.6–2.3%) in 764 lowrisk patients (p=0.002); among patients without prophylaxis, this rate was 3.2% vs 1.5% (p=0.130), respectively. Negative likelihood ratio was 0.28 (95% CI 0.10–0.83) for the Geneva Risk Score and 0.51 (95% CI 0.28–0.93) for the Padua Prediction Score. In conclusion, among hospitalised medical patients, the Geneva Risk Score predicted VTE and VTE-related mortality and compared favourably with the Padua Prediction Score, particularly for its accuracy to identify low-risk patients who do not require thromboprophylaxis.

Keywords

Venous thromboembolism - internal medicine - risk assessment - thromboprophylaxis - validation studies

Full Text

References

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