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Thromb Haemost 2014; 111(03): 531-538
DOI: 10.1160/TH13-05-0427
New Technologies, Diagnostic Tools and Drugs
Schattauer GmbH

Multicentre validation of the Geneva Risk Score for hospitalised medical patients at risk of venous thromboembolism

Explicit ASsessment of Thromboembolic RIsk and Prophylaxis for Medical PATients in SwitzErland (ESTIMATE)
Mathieu Nendaz   *
1   Department of Internal Medicine, University Hospitals Geneva, Switzerland
,
David Spirk   *
2   Medical Department, Sanofi-Aventis (Suisse) SA, Vernier, Switzerland
,
Nils Kucher
3   Swiss Cardiovascular Center, University Hospital Bern, Switzerland
,
Drahomir Aujesky
4   Division of General Internal Medicine, University Hospital Bern, Switzerland
,
Daniel Hayoz
5   Department of Internal Medicine, Cantonal Hospital Fribourg, Switzerland
,
Jürg H. Beer
6   Department of Internal Medicine, Cantonal Hospital Baden, Switzerland
,
Marc Husmann
7   Clinic of Angiology, University Hospital Zurich, Switzerland
,
Beat Frauchiger
8   Department of Internal Medicine, Cantonal Hospital Frauenfeld, Switzerland
,
Wolfgang Korte
9   Department of Internal Medicine, Cantonal Hospital St. Gallen, Switzerland
,
Walter A. Wuillemin
10   Division of Hematology and Central Hematology Laboratory, Cantonal Hospital Lucerne and University of Bern, Switzerland
,
Kurt Jäger
2   Medical Department, Sanofi-Aventis (Suisse) SA, Vernier, Switzerland
,
Marc Righini
1   Department of Internal Medicine, University Hospitals Geneva, Switzerland
,
Henri Bounameaux
1   Department of Internal Medicine, University Hospitals Geneva, Switzerland
› Author Affiliations Financial support: The study was funded by an unrestricted educational grant from the International Society on Thrombosis and Haemostasis (ISTH) 2007 Presidential Fund and Sanofi-Aventis (Suisse) SA, Vernier, Switzerland.
Further Information

Publication History

Received: 27 May 2013

Accepted after major revision: 04 October 2013

Publication Date:
22 November 2017 (online)

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Summary

There is a need to validate risk assessment tools for hospitalised medical patients at risk of venous thromboembolism (VTE). We investigated whether a predefined cut-off of the Geneva Risk Score, as compared to the Padua Prediction Score, accurately distinguishes low-risk from high-risk patients regardless of the use of thromboprophylaxis. In the multicentre, prospective Explicit ASsessment of Thromboembolic RIsk and Prophylaxis for Medical PATients in SwitzErland (ESTIMATE) cohort study, 1,478 hospitalised medical patients were enrolled of whom 637 (43%) did not receive thromboprophylaxis. The primary endpoint was symptomatic VTE or VTE-related death at 90 days. The study is registered at ClinicalTrials.gov, number NCT01277536. According to the Geneva Risk Score, the cumulative rate of the primary endpoint was 3.2% (95% confidence interval [CI] 2.2–4.6%) in 962 high-risk vs 0.6% (95% CI 0.2–1.9%) in 516 low-risk patients (p=0.002); among patients without prophylaxis, this rate was 3.5% vs 0.8% (p=0.029), respectively. In comparison, the Padua Prediction Score yielded a cumulative rate of the primary endpoint of 3.5% (95% CI 2.3–5.3%) in 714 high-risk vs 1.1% (95% CI 0.6–2.3%) in 764 lowrisk patients (p=0.002); among patients without prophylaxis, this rate was 3.2% vs 1.5% (p=0.130), respectively. Negative likelihood ratio was 0.28 (95% CI 0.10–0.83) for the Geneva Risk Score and 0.51 (95% CI 0.28–0.93) for the Padua Prediction Score. In conclusion, among hospitalised medical patients, the Geneva Risk Score predicted VTE and VTE-related mortality and compared favourably with the Padua Prediction Score, particularly for its accuracy to identify low-risk patients who do not require thromboprophylaxis.

Keywords

Venous thromboembolism - internal medicine - risk assessment - thromboprophylaxis - validation studies

* Both authors contributed equally.


 

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