Xin WANG, Xin-yu HONG, Jin-yu LI, Rui-jie ZHAO, Yu-qing YANG, Si-hua LIU, Xue-feng SUN, Wei-guo ZHU, Jun-ping FAN, Ju-hong SHI. Value of Padua Risk Assessment Model in Evaluating Venous Thromboembolism of Hospitalized Patients in the Department of Internal Medicine[J]. Medical Journal of Peking Union Medical College Hospital, 2018, 9(3): 234-241. doi: 10.3969/j.issn.1674-9081.2018.03.009
Citation: Xin WANG, Xin-yu HONG, Jin-yu LI, Rui-jie ZHAO, Yu-qing YANG, Si-hua LIU, Xue-feng SUN, Wei-guo ZHU, Jun-ping FAN, Ju-hong SHI. Value of Padua Risk Assessment Model in Evaluating Venous Thromboembolism of Hospitalized Patients in the Department of Internal Medicine[J]. Medical Journal of Peking Union Medical College Hospital, 2018, 9(3): 234-241. doi: 10.3969/j.issn.1674-9081.2018.03.009

Value of Padua Risk Assessment Model in Evaluating Venous Thromboembolism of Hospitalized Patients in the Department of Internal Medicine

doi: 10.3969/j.issn.1674-9081.2018.03.009
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  • Corresponding author: SHI Ju-hong Tel: 010-69155028, E-mail: shijh@pumch.cn
  • Received Date: 2018-01-03
  • Publish Date: 2018-05-30
  •   Objective   The aim of this study was to investigate the status of venous thromboembolism(VTE)in patients in the department of internal medicine and to evaluate whether Padua risk assessment modelcan be applied to this patient population.   Methods   Baseline information, risk factors, prevention, and the incidence of VTE in in-patients of the department of internal medicine were collected and analyzed at Peking Union Medical College Hospital from May 17, 2016, to September 9, 2016. Patients with or without VTE were compared during hospitalization and within 3 months after discharge. Correlations between risk factors and VTE events were calculated and risk stratification was calculated by Padua risk assessment model. The predictive value was assessed by Logistic regression analysis.   Results   A total of 3115 patients were enrolled in this study. The incidence of VTE was 2.5%(78/3115). The sensitivity and specificity of Padua risk assessment model were 83.3% and 62.3%, respectively, and 38.8% of patients had a high risk of VTE based on this model. The four risk factors embodied in the model including elderly age(≥ 70 years), acute myocardial infarction or ischemic stroke, obesity(body mass index ≥ 30 kg/m2), and recent(≤ 1 month)trauma and/or surgery, showed no statistical difference between patients with and without VTE(P>0.05). However, other risk factors that are not included in Padua risk assessment model, i.e. use of estrogen or progesterone, blood transfusion, and mechanical ventilation showed statistically different between VTE and non-VTE patients(P < 0.01). The ratio of receiving preventive treatment with anticoagulant drugs or machines was significantly higher in high-risk patients than those in low-risk ones(P < 0.01); 85.3% of high-risk patients did not receive anticoagulant or mechanical prevention and did not have VTE either.   Conclusions   Padua risk assessment model shows low specificity. Several risk factors and their weight distribution in the model are not suitable, which leads to the limitation of this model in VTE risk assessment for in-patients of the department of internal medicine.
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  • [1] Cushman M. Epidemiology and risk factors for venous thrombosis[J]. Semin Hematol, 2007, 44:62-69. doi:  10.1053/j.seminhematol.2007.02.004
    [2] Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism:American College of Chest Physicians Evidence-Based Clinical Practice Guidelines(8th Edition)[J]. Chest, 2008, 133:381S-453S. doi:  10.1378/chest.08-0656
    [3] Heit JA, Silverstein MD, Mohr DN, et al. Predictors of survival after deep vein thrombosis and pulmonary embolism:a population-based, cohort study[J]. Arch Intern Med, 1999, 159:445-453. doi:  10.1001/archinte.159.5.445
    [4] Alikhan R, Peters F, Wilmott R, et al. Fatal pulmonary embolism in hospitalised patients:a necropsy review[J]. J Clin Pathol, 2004, 57:1254-1257. doi:  10.1136/jcp.2003.013581
    [5] Vessey M, Mant D, Smith A, et al. Oral contraceptives and venous thromboembolism:findings in a large prospective study[J]. Br Med J(Clin Res Ed), 1986, 292:526. doi:  10.1136/bmj.292.6519.526
    [6] Tyler ET. Oral contraception and venous thrombosis[J]. JAMA, 1963, 185:131-132. doi:  10.1001/jama.1963.03060020091034
    [7] Daly E, Vessey MP, Hawkins MM, et al. Risk of venous thromboembolism in users of hormone replacement therapy[J]. Lancet, 1996, 348:977-980. doi:  10.1016/S0140-6736(96)07113-9
    [8] Vene N. Hormone replacement therapy and venous thromboembolism[J]. Climacteric, 2014, 142:76-82. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=10.1080/13697130802227724
    [9] Chopra V, Anand S, Hickner A, et al. Risk of venous thromboembolism associated with peripherally inserted central catheters:a systematic review and meta-analysis[J]. Lancet, 2013, 382:311-325. doi:  10.1016/S0140-6736(13)60592-9
    [10] Piccioli A, Prandoni P, Ewenstein BM, et al. Cancer and venous thromboembolism[J]. Am Heart J, 1987, 147:694-699. http://med.wanfangdata.com.cn/Paper/Detail/PeriodicalPaper_PM8831376
    [11] Stein PD, Beemath A, Meyers FA, et al. Incidence of venous thromboembolism in patients hospitalized with cancer[J]. Am J Med, 2006, 119:60-68. doi:  10.1016/j.amjmed.2005.06.058
    [12] Sandhu R, Pan CX, Wun T, et al. The incidence of venous thromboembolism and its effect on survival among patients with primary bladder cancer[J]. Cancer, 2010, 116:2596-2603. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=10.1002/cncr.25004
    [13] Anderson FA, Wheeler HB, Goldberg RJ, et al. A popula-tion-based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism. The Worcester DVT Study[J]. Arch Intern Med, 1991, 151:933-938. doi:  10.1001/archinte.1991.00400050081016
    [14] Goldhaber SZ, Grodstein F, Stampfer MJ, et al. A prospective study of risk factors for pulmonary embolism in women[J]. JAMA, 1997, 277:642-645. doi:  10.1001/jama.1997.03540320044033
    [15] Matta F, Singala R, Yaekoub AY, et al. Risk of venous thromboembolism with rheumatoid arthritis[J]. Thromb Haemost, 2009, 101:134-138. doi:  10.1160/TH08-08-0551
    [16] Grainge MJ, West J, Card TR. Venous thromboembolism during active disease and remission in inflammatory bowel disease:a cohort study[J]. Lancet, 2010, 375:657-663. doi:  10.1016/S0140-6736(09)61963-2
    [17] Solem CA, Loftus EV, Tremaine WJ, et al. Venous thromboembolism in inflammatory bowel disease[J].Am J Gastroenterol, 2004, 99:97-101. doi:  10.1046/j.1572-0241.2003.04026.x
    [18] Leizorovicz A, Mismetti P. Preventing venous thromboembo-lism in medical patients[J]. Circulation, 2004, 110:13-19.
    [19] Samama MM, Cohen AT, Darmon JY, et al. A comparison of enoxaparin with placebo for the prevention of venous thromboembolism in acutely ill medical patients. Prophylaxis in Medical Patients with Enoxaparin Study Group[J]. N Engl J Med, 1999, 341:793-800. doi:  10.1056/NEJM199909093411103
    [20] Cohen AT, Davidson BL, Gallus AS, et al. Efficacy and safety of fondaparinux for the prevention of venous thromboembolism in older acute medical patients:randomised placebo controlled trial[J]. Br Med J, 2006, 332:325-329. doi:  10.1136/bmj.38733.466748.7C
    [21] 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, 8:2450-2457. doi:  10.1111/j.1538-7836.2010.04044.x
    [22] Kearon C, Akl EA, Ornelas J, et al. Antithrombotic therapy for VTE disease:CHEST Guideline and Expert Panel Report[J]. Chest, 2016, 149:315-352. doi:  10.1016/j.chest.2015.11.026
    [23] Woo KS, Tse LKK, Tse CY, et al. The prevalence and pattern of pulmonary thromboembolism in the Chinese in Hong Kong[J]. Int J Cardiol, 1988, 20:373-380. doi:  10.1016/0167-5273(88)90291-4
    [24] Liam CK, Ng SC. A review of patients with deep vein thrombosis diagnosed at University Hospital, Kuala Lumpur[J]. Ann Acad Med Singapore, 1990, 19:837-840. http://med.wanfangdata.com.cn/Paper/Detail/PeriodicalPaper_PM2130750
    [25] Lee LH. Clinical update on deep vein thrombosis in Singapore[J]. Ann Acad Med Singapore, 2002, 31:248-252. http://med.wanfangdata.com.cn/Paper/Detail/PeriodicalPaper_PM11957569
    [26] Cheuk BLY, Cheung GCY, Cheng SWK. Epidemiology of venous thromboembolism in a Chinese population[J]. Br J Surg, 2004, 91:424-428. doi:  10.1002/bjs.4454
    [27] Liu X, Liu C, Chen X, et al. Comparison between Caprini and Padua risk assessment models for hospitalized medical patients at risk for venous thromboembolism:a retrospective study[J]. Interact Cardiovasc Thorac Surg, 2016, 23:538-543. doi:  10.1093/icvts/ivw158
    [28] 李积凤, 杨媛华.对《内科住院患者静脉血栓栓塞症预防的中国专家建议》的解读[J].中国医刊, 2016, 51:24-27. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zgyk201604009
    [29] 王倩竹, 黄建平, 曾小兵, 等.结直肠癌患者术后并发静脉血栓栓塞的影响因素分析[J].中国全科医学, 2014, 17:659-662. doi:  10.3969/j.issn.1007-9572.2014.06.015
    [30] Anderson FA, Spencer FA. Risk factors for venous thromboembolism[J]. Circulation, 2003, 107:I9-I16.
    [31] Giordano NJ, Jansson PS, Young MN, et al. Epidemiology, pathophysiology, stratification, and natural history of pulmon-ary embolism[J]. Tech Vasc Interv Radiol, 2017, 20:135-140. doi:  10.1053/j.tvir.2017.07.002
    [32] Duggirala MK, Cook DA, Mauck KF. An association between atherosclerosis and venous thrombosis[J]. N Engl J Med, 2003, 348:401-402.
    [33] Caprini JA, Arcelus JI, Reyna J. Effective risk stratification of surgical and nonsurgical patients for venous thromboembolic disease[J]. Semin Hematol, 2001, 38:12-19. http://med.wanfangdata.com.cn/Paper/Detail/PeriodicalPaper_PM11449339
    [34] 张学辉, 喻姣花, 褚婕, 等.深静脉血栓风险评估研究进展及展望[J].护理研究, 2014, (32):3982-3985. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=sxhlzz201432005
    [35] 闫振宇, 华宝来, 马西虎, 等. 672例静脉血栓栓塞症相关危险因素分析[J].中华血液学杂志, 2007, 28:579-582. doi:  10.3760/j.issn:0253-2727.2007.09.002
    [36] 中华医学会呼吸病学分会.肺血栓栓塞症的诊断与治疗指南(草案)[J].中国临床医生杂志, 2002, 24:26-30. http://www.cnki.com.cn/Article/CJFDTotal-ZLYS200204013.htm
    [37] White RH, Keenan CR. Effects of race and ethnicity on the incidence of venous thromboembolism[J]. Thromb Res, 2009, 123 Suppl 4:S11-S17. doi:  10.1016/S0049-3848(09)70136-7
    [38] White RH, Zhou H, Murin S, et al. Effect of ethnicity and gender on the incidence of venous thromboembolism in a diverse population in California in 1996[J]. Thromb Haemost, 2005, 93:298-305. doi:  10.1160/TH04-08-0506
    [39] Silverstein MD, Heit JA, Mohr DN, et al. Trends in the incidence of deep vein thrombosis and pulmonary embolism:a 25-year population-based study[J]. AMA Arch Intern Med, 1998, 158:585-593. doi:  10.1001/archinte.158.6.585
    [40] White RH, Zhou H, Romano PS. Incidence of idiopathic deep venous thrombosis and secondary thromboembolism among ethnic groups in California[J]. Ann Intern Med, 1998, 128:737-740. doi:  10.7326/0003-4819-128-9-199805010-00006
    [41] Stein PD, Kayali F, Olson RE, et al. Pulmonary thromboembolism in Asians/Pacific Islanders in the United States:analysis of data from the National Hospital Discharge Survey and the United States Bureau of the Census[J]. Am J Med, 2004, 116:435-442. doi:  10.1016/j.amjmed.2003.11.020
    [42] Cohen AT, Tapson VF, Bergmann JF, et al. Venous thromboembolism risk and prophylaxis in the acute hospital care setting(ENDORSE study):a multinational cross-sectional study[J]. Lancet, 2008, 371:387-394. doi:  10.1016/S0140-6736(08)60202-0
    [43] Ge J, Li Y, Jin X, et al. Venous thromboembolism risk assessment and thromboprophylaxis among hospitalized acute medical patients in China-the RAMP study[J]. Thromb Res, 2010, 126:270-275. doi:  10.1016/j.thromres.2010.06.029
    [44] Listed N. Prevention of venous thrombosis and pulmonary embolism. NIH Consensus Development[J]. JAMA, 1986, 256:744-749. doi:  10.1001/jama.1986.03380060070028
    [45] Oger E. Incidence of venous thromboembolism:a community-based study in Western France. EPI-GETBP Study Group. Groupe d'Etude de la Thrombose de Bretagne Occidentale[J]. Thromb Haemost, 2000, 83:657-660. doi:  10.1055/s-0037-1613887
    [46] Zakai NA, Mcclure LA. Racial differences in venous thromboembolism[J]. Thromb Haemost, 2011, 9:1877-1882. doi:  10.1111/j.1538-7836.2011.04443.x
    [47] Bang SM, Jang MJ, Oh D, et al. Korean Guidelines for the Prevention of Venous Thromboembolism[J]. J Korean Med Sci, 2010, 25:1553-1559. doi:  10.3346/jkms.2010.25.11.1553
    [48] Nakamura M. Japanese Guidelines for Prevention of Venous Thromboembolism Guideline[J]. J Jpn Soc Clin Anesth, 2004, 24:480-487. doi:  10.2199/jjsca.24.480
    [49] Caprini JA. Risk assessment as a guide for the prevention of the many faces of venous thromboembolism[J]. Am J Surg, 2010, 199:S3-S10. doi:  10.1016/j.amjsurg.2009.10.006
    [50] Rosenberg D, Eichorn A, Alarcon M, et al. External validation of the risk assessment model of the international medical prevention registry on venous thromboembolism(IMPROVE)for medical patients in a tertiary health system[J]. J Am Heart Assoc, 2014, 3:e001152. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=10.1161/JAHA.114.001152
    [51] Spyropoulos AC, Jr AF, Fitzgerald G, et al. Predictive and associative models to identify hospitalized medical patients at risk for VTE[J]. Chest, 2011, 140:706-714. doi:  10.1378/chest.10-1944
    [52] Wicki J, Perneger TV, Junod AF, et al. Patient-centered research:assessing clinical probability of pulmonary embolism in the emergency ward:a simple score[J]. J Arch Intern Med, 2001, 161:92-97. doi:  10.1001/archinte.161.1.92
    [53] Shi C, Kang X, Wang Y, et al. The coagulation factor V Leiden, MTHFRC677T variant and eNOS 4ab polymorphism in young Chinese population with ischemic stroke[J]. Clin Chim Acta, 2008, 396:7-9. doi:  10.1016/j.cca.2008.06.009
    [54] Jun ZJ, Ping T, Lei Y, et al. Prevalence of factor V Leiden and prothrombin G20210A mutations in Chinese patients with deep venous thrombosis and pulmonary embolism[J]. Clin Lab Haematol, 2006, 28:111-116. doi:  10.1111/j.1365-2257.2006.00757.x
    [55] Crowther MA, Kelton JG. Congenital thrombophilic states associated with venous thrombosis:a qualitative overview and proposed classification system[J]. Ann Intern Med, 2003, 138:128-134. doi:  10.7326/0003-4819-138-2-200301210-00014
    [56] 刘凤林, 秦净, 从指南到实践:解析《中国普通外科围手术期血栓预防与管理指南》[J].协和医学杂志, 2018, 9:44-49. http://www.cqvip.com/QK/70803X/201802/7000450781.html
    [57] 彭斌, 崔丽英.抗凝与出血:临床决策的平衡与选择[J].协和医学杂志, 2018, 9:7-12. http://www.cqvip.com/QK/70803X/201802/7000450774.html
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