Antic et al reported a score for predicting venous thromboembolism in a patient with malignant lymphoma. This can help to identify a patient who may benefit from more aggressive anticoagulation. The authors are from Clinical Centre Serbia, University of Belgrade, Mayo Clinic, and University of Kragujevac.
Patient selection: malignant lymphoma
Parameters:
(1) history of previous venous thromboembolism, acute myocardial infarction or stroke
(2) reduced mobility (ECOG)
(3) body mass index (BMI) in kg per sq m
(4) extranodal disease
(5) mediastinal involvement
(6) absolute neutrophil count in 10^9/L
(7) hemoglobin in g/L
Parameter
|
Finding
|
Points
|
history of thrombosis
|
no
|
0
|
|
yes
|
2
|
mobility
|
ECOG 0 or 1 (normal)
|
0
|
|
ECOG 2 to 4 (reduced)
|
1
|
BMI
|
<= 30 kg per sq m
|
0
|
|
> 30 kg per sq m (obese)
|
2
|
extranodal disease
|
no
|
0
|
|
yes
|
1
|
mediastinal involvement
|
no
|
0
|
|
yes
|
2
|
absolute neutrophil count
|
>= 1 * 10^9/L
|
0
|
|
< 1 * 10^9/L
|
1
|
hemoglobin
|
>= 100 g/L
|
0
|
|
< 100 g/L
|
1
|
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 10
Score
|
Risk of VTE
|
0 or 1
|
low risk
|
2 or 3
|
intermediate risk
|
>=4
|
high risk
|
Performance:
• The negative predictive value for intermediate and high-risk groups was 98.5%.
• The area under the ROC curve was 0.88 in the derivation and 0.86 in the validation cohorts.
• Rupa-Matysek et al found poor performance with an area under the ROC curve of 0.55.
• In the study of Rupa-Matysek et al the patients were undergoing first-line chemotherapy.
• Antic et al states that most events occurred during or within 3 months of chemotherapy.