Derivation and Validation of a Prediction Model for Risk Stratification of Post-Thrombotic Syndrome in Elderly Patients with a First Deep Vein Thrombosis.

Méan, Marie; Limacher, Andreas; Alatri, Adriano; Aujesky, Drahomir; Mazzolai, Lucia (2018). Derivation and Validation of a Prediction Model for Risk Stratification of Post-Thrombotic Syndrome in Elderly Patients with a First Deep Vein Thrombosis. Thrombosis and haemostasis, 118(8), pp. 1419-1427. Schattauer 10.1055/s-0038-1661392

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BACKGROUND  Not all patients carry the same risk of developing a post-thrombotic syndrome (PTS), we therefore aimed to derive a prediction rule for risk stratification of PTS in patients with deep vein thrombosis (DVT). METHODS  Our derivation sample included 276 patients with a first acute symptomatic lower limb DVT enrolled in a prospective cohort. We derived our prediction rule using regression analysis, with the occurrence of PTS within 24 months of a DVT based on the Villalta score as outcome, and 11 candidate variables as predictors. We used bootstrapping methods for internal validation. RESULTS  Overall, 161 patients (58.3%) developed a PTS within 24 months of a DVT. Our prediction rule was based on five predictors (age ≥ 75 years, prior varicose vein surgery, multi-level thrombosis, concomitant antiplatelet/non-steroidal anti-inflammatory drug therapy and the number of leg symptoms and signs). Overall, 16.3, 31.2 and 52.5% of patients were classified as low- (score, 0-3), moderate (score, 4-5) and high-risk (score, ≥ 6), for developing a PTS. Within 24 months of the index DVT, 24.4% of the patients in the low-risk category developed a PTS, 38.4% in the moderate and 80.7% in the high-risk category. The prediction model showed good predictive accuracy (area under the curve, 0.77; 95% confidence interval, 0.71-0.82, calibration slope, 0.90 and Brier score, 0.20). CONCLUSION  This easy-to-use clinical prediction rule accurately identifies patients with DVT who are at high risk of developing PTS within 24 months who could potentially benefit from special educational or therapeutic measures to limit the risk of PTS.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern

UniBE Contributor:

Limacher, Andreas and Aujesky, Drahomir

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

0340-6245

Publisher:

Schattauer

Language:

English

Submitter:

Tanya Karrer

Date Deposited:

05 Jul 2018 13:49

Last Modified:

14 Feb 2019 11:49

Publisher DOI:

10.1055/s-0038-1661392

PubMed ID:

29960276

BORIS DOI:

10.7892/boris.118320

URI:

https://boris.unibe.ch/id/eprint/118320

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