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Comparative Validation of Risk Assessment Models for Venous Thromboembolism Risk in Hospitalized Medical Patients:
Pedro Ruiz-Artacho1, Mónica Olid Velilla2, Fahd Beddar Chaib3
1Internal Medicine Department, Clínica Universidad de Navarra, Madrid, Spain; Interdisciplinar Teragnosis and Radiosomics Research Group (INTRA-Madrid), Universidad de Navarra, Madrid, Spain; CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain.
The American Journal of Medicine
|March 31, 2025
Summary
Current risk assessment models (RAMs) for venous thromboembolism in medical patients show poor accuracy. New, dynamic models are needed for better thromboprophylaxis and patient outcomes.
Area of Science:
- Internal Medicine
- Clinical Risk Management
- Thromboprophylaxis
Background:
- Venous thromboembolism (VTE) risk assessment in hospitalized medical patients lacks an optimal model.
- Evaluating the prognostic performance of established risk assessment models (RAMs) is crucial for clinical practice.
Purpose of the Study:
- To assess the prognostic performance of the Padua, IMPROVE, and NICE guidelines' RAMs for VTE in hospitalized medical patients.
- To compare the discriminative accuracy of these RAMs in a real-world clinical setting.
Main Methods:
- A multicenter prospective observational study involving 1273 consecutive medical inpatients across 15 Spanish hospitals.
- VTE events were monitored over a 90-day follow-up period, with competing risk analyses accounting for non-VTE mortality.
- Performance metrics included sensitivity, specificity, and area under the receiver operating characteristic curve (AUC).
Main Results:
- The 90-day cumulative VTE incidence was 1.0%.
- All evaluated RAMs (Padua, IMPROVE, NICE) demonstrated suboptimal discriminative performance (AUCs: 62.3%, 64.9%, and 50.1%, respectively).
- High-risk stratification by these models did not consistently correlate with significantly increased VTE risk after adjusting for thromboprophylaxis.
Conclusions:
- The Padua, IMPROVE, and NICE RAMs exhibit poor predictive accuracy for VTE risk stratification in hospitalized medical patients.
- There is a critical need for the development of more precise and dynamic RAMs suitable for real-world clinical application.
- Improved RAMs are essential to optimize thromboprophylaxis strategies and enhance patient outcomes in this population.
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