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Thromb Haemost 2018; 118(10): 1823-1831
DOI: 10.1055/s-0038-1670660
Stroke, Systemic or Venous Thromboembolism
Georg Thieme Verlag KG Stuttgart · New York

Venous Thrombosis Risk after Arthroscopy of the Knee: Derivation and Validation of the L-TRiP(ascopy) Score

Banne Nemeth
1   Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
2   Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
,
Raymond A. van Adrichem
1   Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
2   Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
,
Astrid van Hylckama Vlieg
1   Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
,
Trevor Baglin
3   Department of Haematology, Addenbrooke's Hospital, Cambridge, United Kingdom
,
Frits R. Rosendaal
1   Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
,
Rob G. H. H. Nelissen
2   Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
,
Saskia le Cessie
1   Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
4   Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands
,
Suzanne C. Cannegieter
1   Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
5   Department of Thrombosis and Haemostasis, Leiden University Medical Center, Leiden, The Netherlands
› Author Affiliations Funding Netherlands Heart Foundation (grant NHS 98.113), Netherlands Organization for Scientific Research (grant 912–03–033|2003) and Dutch Cancer Foundation (grant RUL 99/1992) funded the study. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.
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Publication History

04 March 2018

08 August 2018

Publication Date:
20 September 2018 (online)

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Abstract

Patients at high risk for venous thrombosis (VT) following knee arthroscopy could potentially benefit from thromboprophylaxis. We explored the predictive values of environmental, genetic risk factors and levels of coagulation markers to integrate these into a prediction model. Using a population-based case–control study into the aetiology of VT, we developed a Complete (all variables), Screening (easy to use in clinical practice) and Clinical (only environmental risk factors) model. The Clinical model was transformed into the Leiden-Thrombosis Risk Prediction (arthroscopy) score [L-TRiP(ascopy) score]. Model validation was performed both internally and externally in another case–control study. A total of 4,943 cases and 6,294 controls were maintained in the analyses, 107 cases and 26 controls had undergone knee arthroscopy. Twelve predictor variables (8 environmental, 3 haemorheological and 1 genetic) were selected from 52 candidates and incorporated into the Complete model (area under the curve [AUC] of 0.81, 95% confidence interval [CI], 0.76–0.86). The Screening model (9 predictors: environmental factors plus factor VIII activity) reached an AUC of 0.76 (95% CI, 0.64–0.88) and the Clinical (and corresponding L-TRiP(ascopy)) model an AUC of 0.72 (95% CI, 0.60–0.83). In the internal and external validation, the Complete model reached an AUC of 0.78 (95% CI, 0.52–0.98) and 0.75 (95% CI, 0.42–1.00), respectively, while the other models performed slightly less well.

Keywords

venous thrombosis - risk factors - epidemiological studies - orthopaedics - prevention

Authors' Contributions

B. Nemeth, R.A. van Adrichem, R.G.H.N. Nelissen, S.C. Cannegieter and F.R. Rosendaal designed the research. T. Baglin, F.R. Rosendaal and A. van Hylckama Vlieg enrolled patients. B. Nemeth and S. le Cessie performed the analyses. B. Nemeth wrote the first draft of the manuscript. All authors critically revised the manuscript content. B. Nemeth takes full responsibility for data analyses and all authors take responsibility for the interpretation of the data. All authors have read, and confirm that they meet, ICMJE criteria for authorship.


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