Introduction Hospital-acquired thrombosis accounts for a large proportion of all venous thromboembolism (VTE), with significant morbidity and mortality. This subset of VTE can be reduced through accurate risk assessment and tailored pharmacological thromboprophylaxis. This systematic review aimed to determine the comparative accuracy of risk assessment models (RAMs) for predicting VTE in patients admitted to hospital. Methods A systematic search was performed across five electronic databases (including MEDLINE, EMBASE and the Cochrane Library) from inception to February 2021. All primary validation studies were eligible if they examined the accuracy of a multivariable RAM (or scoring system) for predicting the risk of developing VTE in hospitalised inpatients. Two or more reviewers independently undertook study selection, data extraction and risk of bias assessments using the PROBAST (Prediction model Risk Of Bias ASsessment Tool) tool. We used narrative synthesis to summarise the findings. Results Among 6355 records, we included 51 studies, comprising 24 unique validated RAMs. The majority of studies included hospital inpatients who required medical care (21 studies), were undergoing surgery (15 studies) or receiving care for trauma (4 studies). The most widely evaluated RAMs were the Caprini RAM (22 studies), Padua prediction score (16 studies), IMPROVE models (8 studies), the Geneva risk score (4 studies) and the Kucher score (4 studies). C-statistics varied markedly between studies and between models, with no one RAM performing obviously better than other models. Across all models, C-statistics were often weak ( 0.8). Similarly, estimates for sensitivity and specificity were highly variable. Sensitivity estimates ranged from 12.0% to 100% and specificity estimates ranged from 7.2% to 100%. Conclusion Available data suggest that RAMs have generally weak predictive accuracy for VTE. There is insufficient evidence and too much heterogeneity to recommend the use of any particular RAM. PROSPERO registration number Steve Goodacre, Abdullah Pandor, Katie Sworn, Daniel Horner, Mark Clowes. A systematic review of venous thromboembolism RAMs for hospital inpatients. PROSPERO 2020 CRD42020165778. Available from https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=165778https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=165778

https://bmjopen.bmj.com/content/bmjopen/11/7/e045672.full.pdf

Risk assessment models for venous thromboembolism in hospitalised adult patients: a systematic review

We present a systemic review of available literature on the complications of deep venous thrombosis that develops in patients presenting with acute stroke. There are several pharmacological and physical treatment options available and used. We aim to summarize the management plans currently used at different centers. In conclusion, low-dose anticoagulant therapy for ischemic stroke is recommended. In the case of intracerebral hemorrhage, pneumatic sequential compression devices should be placed initially, followed by the administration of ultra-fractioned heparin on the next day, and then oral anticoagulant therapy to replace the heparin after a week in high-risk patients. Similar prophylactic treatment recommendations are used for subarachnoid hemorrhage.

/pdf/deep-vein-thrombosis-in-acute-stroke-a-systemic-review-of-3otvgyxqam.pdf

Deep Vein Thrombosis in Acute Stroke - A Systemic Review of the Literature.

The objective is to determine whether a low serum 25-hydroxyvitamin D (25(OH)D) level is associated with an increased incidence of deep venous thromboembolic events in patients with ischemic stroke. One hundred eighty persons admitted consecutively for inpatient rehabilitation at the Department of Rehabilitation of the First Affiliated Hospital of Wenzhou Medical University with a diagnosis of ischemic stroke from January 2015 to December 2015 were enrolled. The following demographic data were collected: age, sex, body mass index, and history of risk factors. The levels of 25(OH)D and the presence of deep vein thrombosis (DVT) by routine duplex imaging were also recorded. The value of 25(OH)D needed to predict DVT was analyzed using logistic regression analysis, after adjusting for the possible confounders. We found that 80% of patients admitted to the acute inpatient rehabilitation unit had low levels of vitamin D. Forty-seven patients had DVT, and the incidence of DVT was 26.1% within 3 weeks after the stroke event. With all patients taken together, DVT occurrence as a dependent variable with the sufficient group as the reference used for vitamin D levels in the logistic analysis, deficiency of vitamin D was independently associated with the development of DVT (odds ratio = 4.683, 95% confidence interval: 1.396-15.703, P = .012). In conclusion, low serum 25(OH)D levels were independent predictors of DVT in patients with ischemic stroke during inpatient rehabilitation stay in China. This finding reveals the critical role played by 25(OH)D in the pathogenesis of DVT.

https://journals.sagepub.com/doi/pdf/10.1177/1076029618786574

Low Vitamin D Levels Are Associated With the Development of Deep Venous Thromboembolic Events in Patients With Ischemic Stroke.

Priority Nursing Interventions Caring for the Stroke Patient.

Risk factors and predictors for venous thromboembolism in people with ischemic stroke: A systematic review

Summary

Aims

Deep-vein thrombosis (DVT) represents a serious complication in acute stroke patients with pulmonary embolus (PE) as a potential outcome. Prediction of DVT may help with formulating a proper prevention strategy. To assess of the risk of deep venous thrombosis (DVT) in acute stroke patients, we developed and validated a clinical score in a cohort study.



Methods

Incidence of Deep Venous Thrombosis after Acute Stroke in China (INVENT-China) is a multicenter prospective cohort study. The potential predictive variables for DVT at baseline were collected, and the presence of DVT was evaluated using ultrasonography on the 14 ± 3 days. Data were randomly assigned to either a training data set or a test data set. Multivariate logistic regression analysis was used to develop risk scores to predict DVT in the training data set and the area under the receiver operating characteristic curve to validate the score in the test data set.



Results

From 2006–2007, 862 hospital-based acute stroke patients were enrolled in China. The overall incidence of DVT after acute stroke within two weeks was 12.4% (95%CI 10.3–14.7%). A seven-point score derived in the training data set (age [≥65 years = 1], sex [female gender = 1]), obesity [BMI ≥ 25 kg/m2 = 1], active cancer [yes = 2], stroke subtype [cerebral hemorraghe = 1], muscle weakness [≥2 on Lower limb NIHSS score = 1] was highly predictive of 14-day risk of DVT(c statistic = 0.70, 95% CI, 0.64–0.76, P < 0.001), in the overall study population(c statistic = 0.65, 95% CI 0.59–0.70, P < 0.001).



Conclusions

This clinical score may help identify acute stroke patients with high risk of DVT. In addition, it also serves as a platform to develop further models of DVT prediction in stroke patients based on clinical factors.

/pdf/risk-assessment-of-deep-vein-thrombosis-after-acute-stroke-a-3hrwsjc8v2.pdf

Risk Assessment of Deep-Vein Thrombosis After Acute Stroke: a Prospective Study Using Clinical Factors

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Risk Assessment of Deep-Vein Thrombosis After Acute Stroke: a Prospective Study Using Clinical Factors