Download PDF
Thromb Haemost 2017; 117(08): 1630-1636
DOI: 10.1160/TH17-02-0116
Stroke, Systemic or Venous Thromboembolism
Schattauer GmbH

Low discriminating power of the modified Ottawa VTE risk score in a cohort of patients with cancer from the RIETE registry

Adriano Alatri
1   Division of Angiology, Lausanne University Hospital, Lausanne, Switzerland
,
Lucia Mazzolai
1   Division of Angiology, Lausanne University Hospital, Lausanne, Switzerland
,
Carme Font
2   Institut Clinic de Malalties Hemato-Oncològiques (ICMHO), Hospital Clínic de Barcelona, Barcelona, Spain
,
Alfonso Tafur
3   Department of Medicine - Cardiology-Vascular Section, Northshore University HealthSystem, Evanston, Illinois, USA
,
Reina Valle
4   Department of Internal Medicine, Hospital Sierrallana, Santander, Spain
,
Pablo Javier Marchena
5   Department of Internal Medicine and Emergency, Parc Sanitari Sant Joan de Deu-Hospital General, Barcelona, Spain
,
Aitor Ballaz
6   Department of Pneumology, Hospital de Galdakao, Vizcaya, Spain
,
Eros Tiraferri
7   Department of Haemostasis and Thrombosis, Ospedale Infermi, Rimini, Italy
,
Llorenç Font
8   Department of Haematology, Hospital de Tortosa Verge de la Cinta, Tarragona, Spain
,
Manuel Monreal
9   Department of Internal Medicine, Hospital Universitario Germans Trias i Pujol de Badalona, Barcelona, Universidad Católica de Murcia, Spain
,
the RIETE Investigators › Author Affiliations
Further Information

Publication History

Received: 21 February 2017

Accepted after major revision: 27 April 2017

Publication Date:
22 November 2017 (online)

    Permissions and Reprints

Summary

Treatment of patients with cancer-associated venous thromboembolism (VTE) remains a major challenge. The modified Ottawa score is a clinical prediction rule evaluating the risk of VTE recurrences during the first six months of anticoagulant treatment in patients with cancer-related VTE. We aimed to validate the Ottawa score using data from the RIETE registry. A total of 11,123 cancer patients with VTE were included in the analysis. According to modified Ottawa score, 2,343 (21%) were categorised at low risk for VTE recurrences, 4,525 (41%) at intermediate risk, and 4,255 (38%) at high risk. Overall, 477 episodes of VTE recurrences were recorded during the course of anticoagulant therapy, with an incidence rate for low, intermediate, and high risk groups of 6.88% (95% CI 5.31–8.77), 11.8% (95% CI 10.1–13.6), and 21.3% (95% CI 18.8–24.1) patient-years, respectively. Overall mortality had an incidence rate of 21.1% (95% CI 18.2–24.3), 79.4% (95% CI: 74.9–84.1), and 134.7% (95% CI: 128.3–141.4) patient-years, respectively. The accuracy and discriminating power of the modified Ottawa score for VTE recurrence was modest, with low sensitivity, specificity and positive predictive value, and a C-statistics of 0.58 (95% CI: 0.56–0.61). In our analysis, the modified Ottawa score did not accurately predict VTE recurrence among patients with cancer-associated thrombosis, thus hindering its use in clinical practice. It is time to define a new score including other clinical predictors.

Keywords

Venous thromboembolism - venous thrombosis - recurrence - neoplasms - decision support techniques

* A full list of the RIETE investigators is given in the Appendix.


 

  • References

  • 1 Blom JW, Doggen CJ, Osanto S. et al. Malignancies, prothrombotic mutations, and the risk of venous thrombosis. J Am Med Assoc 2005; 293: 715-722.
    CrossrefPubMedGoogle Scholar
  • 2 Wun T, White RH. Epidemiology of cancer-related venous thromboembolism. Best Pract Res Clin Haematol 2009; 22: 9-23.
    CrossrefPubMedGoogle Scholar
  • 3 Kearon C, Akl EA, Ornelas J. et al. Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest 2016; 149: 315-352.
    CrossrefPubMedGoogle Scholar
  • 4 Lyman GH, Bohlke K, Khorana AA. et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: american society of clinical oncology clinical practice guideline update 2014. J Clin Oncol 2015; 33: 654-656.
    CrossrefPubMedGoogle Scholar
  • 5 Akl EA, Kahale L, Barba M. et al. Anticoagulation for the long-term treatment of venous thromboembolism in patients with cancer. Cochrane Database Syst Rev 2014; 07: CD006650.
    PubMedGoogle Scholar
  • 6 Louzada ML, Carrier M, Lazo-Langner A. et al. Development of a clinical prediction rule for risk stratification of recurrent venous thromboembolism in patients with cancer-associated venous thromboembolism. Circulation 2012; 126: 448-454.
    CrossrefPubMedGoogle Scholar
  • 7 den Exter PL, Kooiman J, Huisman MV. Validation of the Ottawa prognostic score for the prediction of recurrent venous thromboembolism in patients with cancer-associated thrombosis. J Thromb Haemost 2013; 11: 998-1000.
    CrossrefPubMedGoogle Scholar
  • 8 Astruc N, Ianotto JC, Metges JP. et al. External validation of the modified Ottawa score for risk stratification of recurrent cancer-associated thrombosis. Eur J Intern Med 2016 Epub ahead of print.
    PubMedGoogle Scholar
  • 9 Khorana AA, Kamphuisen PW, Meyer G. et al. Tissue Factor As a Predictor of Recurrent Venous Thromboembolism in Malignancy: Biomarker Analyses of the CATCH Trial. J Clin Oncol 2016; Jco2016674564.
    PubMedGoogle Scholar
  • 10 Ahn S, Lim KS, Lee YS. et al. Validation of the clinical prediction rule for recurrent venous thromboembolism in cancer patients: the Ottawa score. Support Care Cancer 2013; 21: 2309-2313.
    CrossrefPubMedGoogle Scholar
  • 11 Monreal M, Kakkar AK, Caprini JA. et al. The outcome after treatment of venous thromboembolism is different in surgical and acutely ill medical patients. Findings from the RIETE registry. J Thromb Haemost 2004; 02: 1892-1898.
    CrossrefPubMedGoogle Scholar
  • 12 Monreal M, Trujillo-Santos J. Lessons from VTE registries: the RIETE experience. Best Pract Res Clin Haematol 2009; 22: 25-33.
    CrossrefPubMedGoogle Scholar
  • 13 Prandoni P, Cogo A, Bernardi E. et al. A simple ultrasound approach for detection of recurrent proximal-vein thrombosis. Circulation 1993; 88: 1730-1735.
    CrossrefPubMedGoogle Scholar
  • 14 Remy-Jardin M, Remy J, Wattinne L. et al. Central pulmonary thromboembolism: diagnosis with spiral volumetric CT with the single-breath-hold technique--comparison with pulmonary angiography. Radiology 1992; 185: 381-387.
    CrossrefPubMedGoogle Scholar
  • 15 Kearon C, Iorio A, Palareti G. Risk of recurrent venous thromboembolism after stopping treatment in cohort studies: recommendation for acceptable rates and standardized reporting. J Thromb Haemost 2010; 08: 2313-2315.
    CrossrefPubMedGoogle Scholar
  • 16 Trujillo-Santos J, Nieto JA, Tiberio G. et al. Predicting recurrences or major bleeding in cancer patients with venous thromboembolism. Findings from the RIETE Registry. Thromb Haemost 2008; 100: 435-439.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Napolitano M, Saccullo G, Malato A. et al. Optimal duration of low molecular weight heparin for the treatment of cancer-related deep vein thrombosis: the Cancer-DACUS Study. J Clin Oncol 2014; 32: 3607-3612.
    CrossrefPubMedGoogle Scholar