Li et al reported a score for identifying a patient receiving immunomodulatory drug therapy who is at increased risk for venous thrombosis. This can help to identify a patient who may require more aggressive management. The authors are from University of Washington, Ferd Hutchinson Cancer Centter, St. Louis Veterans Affairs Medica Center, University of Vermont and Washington University in St. Louis.
Patient selection: immunomodulatory therapy in multiple myeloma, age > 65 years
Parameters:
(1) prior surgery in past 90 days (S)
(2) Asian race (A)
(3) history of venous thromboembolism (V)
(4) elderly age (E)
(5) dexamethasone dose (D)
Parameter
Finding
Points
history of prior surgery
no
0
yes
2
race
Asian
-3
other
0
history of VTE
no
0
yes
3
age in years
< 80 years
0
>= 80 years
1
dexamethasone dose
no
0
standard
1
high
2
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: -3 (-2 if everyone on dexamethasone)
• maximum score: 8
• A patient identified as high risk should be considered for prophylactic anticoagulation.
Total Score
Risk Group
6-Month Risk Thrombosis
< 2
low
7%
>= 2
high
12%
Performance:
• The area under the ROC curve was 0.61.
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