Risk Assessment for Venous Thromboembolism in Patients With Neuroepithelial Tumors: Pretreatment Score to Identify High Risk Patients

Abstract

The independent risk factors for venous thromboembolism (VTE) were investigated in patients with neuroepithelial tumor to establish a risk score for VTE. Our prospective study enrolled 395 hospitalized cases with neuroepithelial tumors. All cases underwent measurement of serum D-dimer concentration and neurological examination on admission. Serum D-dimer concentration was measured on days 1, 3, and 7 after surgery and weekly during follow up in patients who underwent surgery, and once a week during follow up in patients without surgery. Fourteen clinical parameters were evaluated as indicators of VTE, and among them, age, body-mass index, chemotherapy, radiation therapy, corticosteroid usage, pretreatment serum D-dimer concentration, paresis of the lower extremity (manual muscle test: MMT), performance status, and World Health Organization grade of the tumor achieved statistical significance. Multivariable logistic regression analysis demonstrated age >65 years, corticosteroid usage, paresis of the lower extremity, and serum D-dimer concentration over 1.0 mg/dl were independent factors. Total risk score was defined as the total of the scores for risk factors assigned based on the adjusted odds ratio: pretreatment serum D-dimer concentration over 1.0 mg/dl (2 points), and age over 65 years old, paresis of the lower extremity of MMT ≤2, and corticosteroid usage (1 point each). Rates of VTE were 2.0% in the low risk (total score 0 or 1), 14.8% in the intermediate risk (total score 2 or 3), and 51.9% in the high risk groups (total score = 4 or 5). This pretreatment risk score for VTE might be useful to identify patients who would benefit from thromboprophylaxis.