The IMPROVEDD VTE Risk Score: Incorporation of D-Dimer into the IMPROVE Score to Improve Venous Thromboembolism Risk...

Area of Science:

• Internal Medicine
• Cardiology
• Hematology

Background:

• The IMPROVE score is a validated tool for assessing venous thromboembolism (VTE) risk in hospitalized medical patients.
• The study aimed to enhance VTE risk identification by incorporating D-dimer measurements into the existing IMPROVE score.

Purpose of the Study:

• To evaluate the association of the IMPROVE score and elevated D-dimer levels with VTE risk.
• To derive and validate a new risk assessment tool, the IMPROVEDD score, by combining the IMPROVE score with D-dimer measurements.

Main Methods:

• A cohort of 7,441 hospitalized medical patients from the APEX trial was analyzed.
• Cox regression analysis was used to derive the IMPROVEDD score, adding two points for D-dimer levels ≥2 times the upper limit of normal (ULN).
• The study assessed the risk of symptomatic deep vein thrombosis, nonfatal pulmonary embolism, or VTE-related death.

Main Results:

• Baseline D-dimer levels were independently associated with symptomatic VTE within 77 days (adjusted HR: 2.22).
• Incorporating D-dimer improved VTE risk discrimination (ΔAUC: 0.06) and reclassification (continuous NRI: 0.34).
• Patients with an IMPROVEDD score ≥2 exhibited a significantly higher VTE risk (HR: 2.73) compared to those with scores of 0-1.

Conclusions:

• The addition of D-dimer measurement to the IMPROVE score (creating the IMPROVEDD score) enhances VTE risk stratification in hospitalized medical patients.
• An IMPROVEDD score of ≥2 effectively identifies patients at heightened risk for VTE up to 77 days.
• This refined risk assessment tool aids in managing thromboprophylaxis in high-risk populations.