Yamaki et al reported a score for predicting adverse outcomes in a patient with lower limb deep vein thrombosis and pulmonary embolism. This can help to identify a patient who may benefit from more aggressive management. The authors are from Tokyo Women's Medical University.
Patient selection: deep vein thrombosis with pulmonary embolism
Outcome: adverse outcome over the next 12 months (recurrent pulmonary embolism, death due to pulmonary embolism, sudden death)
Parameters:
(1) active cancer
(2) adequacy of anticoagulation (with INR level)
(3) leg symptoms
(4) gender
(5) presence of deep vein thrombosis
(6) presence of proximal deep vein thrombosis (DVT; involves the common femoral, femoral or popliteal veins)
(7) previous history of deep vein thrombosis (DVT)
|
Parameter
|
Finding
|
Points
|
|
active cancer
|
no
|
0
|
|
|
yes
|
2
|
|
adequacy of anticoagulation
|
adequate
|
0
|
|
|
inadequate
|
1
|
|
leg symptoms
|
no
|
0
|
|
|
yes
|
1
|
|
gender
|
female
|
0
|
|
|
male
|
2
|
|
deep vein thrombosis
|
no
|
0
|
|
|
yes
|
1
|
|
proximal deep vein thrombosis
|
no
|
0
|
|
|
yes
|
1
|
|
previous history of deep vein thrombosis
|
no
|
0
|
|
|
yes
|
2
|
where:
• Presumably a person cannot have the pattern of absent DVT and present proximal DVT.
total score =
= SUM(points for all 7 parameters)
Interpretation:
• minimum score: 0
• maximum score: 10
• A score >= 5 is high risk for adverse outcomes.
• A score <= 4 is low risk for adverse outcomes, the lower the better.
Performance:
• The area under the ROC curve is 0.84.
