OC 60.1 - Performance of clinical decision rules for venous thromboembolism in patients with a history of thrombosis

Tuesday, July 12, 2022

2:45 PM – 3:00 PM

Location: ExCel Center, ICC Auditorium

Presentation Format: In-Person

Presenting Author(s)

Vicky Mai, MD MSc

MD, MSc
Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
Ottawa, Ontario, Canada

Co-Author(s)

Frederikus A. Klok, MD, PhD

MD, PhD
Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
Leiden, Zuid-Holland, Netherlands
Marc Righini, MD

MD
Division of Angiology and Hemostasis, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
Geneve, Geneve, Switzerland
Sam Schulman, MD, PhD

MD, PhD
Department of Medicine, Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada.
Hamilton, Ontario, Canada
VT

Venkatesh Thiruganasambandamoorthy

MD, MSc
University of Ottawa, Department of Emergency Medicine, Ottawa, Ontario, Canada
Ottawa, Ontario, Canada
SK

Susan R. Kahn

MD, MSc
McGill University, Montreal, QC, Canada
Montreal, Quebec, Canada
VB

Veronica Bates

BSc
Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
Ottawa, Ontario, Canada
AP

Amanda Pecarskie

BSc
Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
Ottawa, Ontario, Canada
MK

Michael J. Kovacs

MD
Division of Hematology, Department of Medicine, University of Western Ontario, London, Ontario, Canada.
London, Ontario, Canada
SV

Shaun Visser

MD
Department of Emergency Medicine, Hôpital Monfort, Ottawa, Ontario, Canada
Ottawa, Ontario, Canada
SS

Sudeep Shivakumar

MD
Department of Medicine, Dalhousie University, Nova Scotia Health, Halifax, Nova Scotia, Canada
Halifax, Nova Scotia, Canada
MT

Melanie Tan

MD
Amsterdam University Medical Center, Amsterdam, Netherlands
Amsterdam, Noord-Holland, Netherlands
EM

Emily S. L. Martens

PhD Student
Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
Leiden, Zuid-Holland, Netherlands
MR

Marc A. Rodger

Professor
Department of Medicine, McGill University, McGill University Health Center, Montreal, Quebec, Canada
Montreal, Quebec, Canada
DS

Dimitrios Scarvelis

MD
Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
Ottawa, Ontario, Canada
AD

Aurélien Delluc

Professor, MD, PhD
Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada.
Ottawa, Ontario, Canada
PG

Philippe Girard

MD
Département de Pneumologie, Institut Mutualiste Montsouris, Paris, France; F-CRIN INNOVTE Network, Saint-Etienne, France
Saint-Étienne, Rhone-Alpes, France
MH

Menno V. Huisman

MD, PhD
Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
Leiden, Zuid-Holland, Netherlands
PW

Philip S. Wells

MD, MSc
Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
Ottawa, Ontario, Canada
Gregoire Le Gal, MD PhD

MD, PhD
Ottawa Hospital Research Institute, University of Ottawa, Canada
Ottawa, Ontario, Canada

Background: Amongst patients with clinically suspected venous thromboembolism (VTE), about 20% are suspected recurrences. Diagnosing recurrent VTE may be challenging. Interpretation of diagnostic tests usually rely on clinical pre-test probability based on clinical decision rules (CDR). However, current CDR have not been validated in patients with a history of VTE.

Aims: To assess and refine the diagnostic algorithm in patients with suspected recurrent VTE. In the present analysis, we reported the accuracy and usefulness of Wells deep vein thrombosis (DVT), Wells pulmonary embolism (PE) and revised Geneva CDR in patients with a clinically suspected recurrent VTE.

Methods: We conducted an international prospective multicenter observational cohort study (PREDICTORS study) of outpatients with suspected VTE recurrence seen in the Emergency Departments or Thrombosis Clinics. Diagnostic management was performed based on usual clinical practices. Standardized case report forms of predictors and diagnostic tests were completed. Wells DVT score was computed in patients with suspected DVT. Wells PE and revised Geneva score were computed in patients with suspected PE. All patients were followed for 3 months and all suspected recurrent episodes during follow-up were independently adjudicated.

Results: 723 patients were included. Amongst patients with suspected DVT, 18/144 (12.5%) and 115/306 (37.6%) patients had a VTE recurrence at baseline and during follow-up in the Wells DVT unlikely and likely groups, respectively. Amongst patients with suspected PE, 14/90 (15.6%), 64/183 (35.0%) and 25/44 (56.8%) patients had a VTE recurrence in the Wells PE low, moderate and high-risk groups, respectively. Based on the revised Geneva score, VTE recurrence occurred in 4/50 (8.0%), 67/209 (32.1%) and 32/58 (55.2%) in the low, intermediate, and high-risk groups, respectively.

Conclusion(s): Wells DVT, Wells PE and revised Geneva CDR are able to risk stratify patients with suspected VTE recurrence. Further studies are needed to improve the yield of non-imaging diagnostic modalities.