A Prospective Observational Cohort of Clinical Outcomes in Medical Inpatients prescribed Pharmacological Thromboprophylaxis Using Different Clinical Risk Assessment Models(COMPT RAMs)

Nibal Chamoun,Hady Ghanem,Gaby Tayeh,Stephanie Matta,Pascale Salameh,Elie Haddad,Rami Salibi,Sandrine Sarine Aderian

doi:10.1038/s41598-019-54842-3

Abstract

The Caprini and Padua venous thromboembolism (VTE) risk assessment models (RAMs) are used to assess VTE risk in surgical and in medical patients respectively. This study aims to compare the proportion of medical inpatients eligible for VTE prophylaxis using the hospital Caprini-based RAM to using the Caprini and Padua RAMs and to assess the associated clinical outcomes. In a prospective observational study, we assessed 297 adult medical inpatients for whom VTE thromboprophylaxis was initiated according to the hospital Caprini-based RAM, referred to as the Lebanese American University Medical Center RAM (LAUMC-RAM). The Padua, Caprini and IMPROVE bleeding risk scores were also assessed for all patients. Bleeding and thromboembolism were evaluated at 14 and 30 days post VTE risk assessment. Pharmacologic thromboprophylaxis was warranted in 97.6%, 99.7%, and 52.9% of patients using the Caprini-based, Caprini, and Padua RAMs respectively. The Caprini-based and Caprini RAMs were highly correlated (r = 0.873 p < 0.001) and were significantly less correlated with the Padua RAM. Major and overall bleeding occurred in 1.4% and 9.2% respectively. VTE was reported in 0.4% with no VTE related mortality. In hospitalized medical patients, the Caprini-based RAM can accurately distinguish low and high VTE risk without resulting in increased risk of bleeding.

Highlights

All hospitalized patients should have their venous thromboembolism (VTE) risk status determined and prophylactic measures instituted if deemed appropriate
The primary objective was to compare the proportion of patients considered at high risk for VTE according to 2 published risk assessment models and to compare these results with the proportion identified by the Lebanese American University Medical Center (LAUMC)-RAM for VTE
In parallel to the data collection of the thrombosis risk factor assessment form completed by the medical team and available in the chart, a study investigator prospectively completed three other scores on admission: the Padua RAM, Caprini RAM and the Improve bleeding risk score which were not shared with the patient or the treating medical team in order not to influence the physicians’ clinical practice

Summary

Introduction

All hospitalized patients should have their VTE risk status determined and prophylactic measures instituted if deemed appropriate. Several hospitals in Lebanon have adopted this score that was recommended by a VTE prevention awareness campaign This score was based on the Caprini RAM, which was initially developed in medical and surgical patients and extensively validated in surgical patients[13,14,15,16]. In the current prospective study we used our institution-specific, Caprini-based, RAM (LAUMC-RAM) on a cohort of medical patients and compared it to both the Padua and Caprini RAM in its ability to accurately risk stratify non-surgical patients into low and high VTE risk groups. The primary objective was to compare the proportion of patients considered at high risk for VTE (and eligible for VTE prophylaxis) according to 2 published risk assessment models (the Padua prediction and the Caprini scores) and to compare these results with the proportion identified by the LAUMC-RAM for VTE. Other secondary endpoints included the concordance of the institutional Caprini-based RAM with the guideline recommended risk assessment models

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Conclusion