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Semin Thromb Hemost 2017; 43(08): 871-876
DOI: 10.1055/s-0037-1604086
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Modified Ottawa Score and Clinical Events in Hospitalized Patients with Cancer-Associated Thrombosis from the Swiss VTE Registry

Adriano Alatri
1   Division of Angiology, Lausanne University Hospital, Lausanne, Switzerland
,
Lucia Mazzolai
1   Division of Angiology, Lausanne University Hospital, Lausanne, Switzerland
,
Nils Kucher
2   Division of Vascular Medicine, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland
,
Drahomir Aujesky
3   Division of General Internal Medicine, Bern University Hospital, Bern, Switzerland
,
Jürg H. Beer
4   Department of Internal Medicine, Cantonal Hospital Baden, Baden, Switzerland
,
Thomas Baldi
5   Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
,
Martin Banyai
6   Department of Internal Medicine, Cantonal Hospital Lucerne, Lucerne, Switzerland
,
Daniel Hayoz
7   Department of Internal Medicine, Cantonal Hospital Fribourg, Fribourg, Switzerland
,
Thomas Kaeslin
8   Department of Internal Medicine, Cantonal Hospital Obwalden, Sarnen, Switzerland
,
Wolfgang Korte
9   Department of Internal Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
,
Robert Escher
10   Department of Internal Medicine, Regional Hospital Burgdorf, Burgdorf, Switzerland
,
Marc Husmann
11   Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
,
Beat Frauchiger
12   Department of Internal Medicine, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland
,
Rolf P. Engelberger
2   Division of Vascular Medicine, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland
7   Department of Internal Medicine, Cantonal Hospital Fribourg, Fribourg, Switzerland
,
Iris Baumgartner
2   Division of Vascular Medicine, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland
,
David Spirk
13   Institute of Pharmacology, University of Bern, Bern, Switzerland
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Publikationsdatum:
04. August 2017 (online)

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Abstract

The modified Ottawa score (MOS) predicted venous thromboembolism (VTE) recurrence in a cohort of patients with cancer-associated thrombosis mainly managed on an outpatient basis. We aimed to assess the prognostic value of the MOS in hospitalized patients with cancer-associated thrombosis. In 383 hospitalized patients with cancer-associated VTE from the SWIss VTE Registry, 98 (25%) were classified as low risk, 175 (46%) as intermediate risk, and 110 (29%) as high risk for VTE recurrence based on the MOS. Clinical end points were recurrent VTE, fatal VTE, major bleeding, and overall mortality at 90 days. Overall, 179 (47%) patients were female, 172 (45%) had metastatic disease, and 72 (19%) prior VTE. The primary site of cancer was lung in 48 (13%) patients and breast in 43 (11%). According to the MOS, the rate of VTE recurrence was 4.1% for low, 6.3% intermediate, and 5.5% high risk (p = 0.75); the rate of fatal VTE was 0.8, 1.9, and 2.0% (p = 0.69); the rate of major bleeding was 3.1, 4.1, and 3.6% (p = 0.92); and the rate of death was 6.1, 12.0, and 28.2% (p < 0.001), respectively. None of the MOS items was associated with VTE recurrence: female gender hazard ratio (HR) 1.26 (95% confidence interval [CI], 0.53–2.96), lung cancer HR 1.17 (95% CI, 0.35–3.98), prior VTE HR 0.44 (95% CI, 0.10–1.91), breast cancer HR 0.83 (95% CI, 0.19–3.58), and absence of metastases HR 0.74 (95% CI, 0.31–1.74). In hospitalized patients with cancer-associated VTE, the MOS failed to predict VTE recurrence at 3 months but was associated with early mortality.

Keywords

cancer - mortality - modified Ottawa score - venous thromboembolism