title: A prognostic score to identify low-risk outpatients with acute deep vein thrombosis in the lower limbs.
abstract: BACKGROUND
  No prior studies have identified which patients with deep vein thrombosis in the lower limbs are at a low risk for adverse events within the first week of therapy.
  
  
  METHODS
  We used data from the Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) to identify patients at low risk for the composite outcome of pulmonary embolism, major bleeding, or death within the first week. We built a prognostic score and compared it with the decision to treat patients at home.
  
  
  RESULTS
  As of December 2013, 15,280 outpatients with deep vein thrombosis had been enrolled. Overall, 5164 patients (34%) were treated at home. Of these, 12 (0.23%) had pulmonary embolism, 8 (0.15%) bled, and 4 (0.08%) died. On multivariable analysis, chronic heart failure, recent immobility, recent bleeding, cancer, renal insufficiency, and abnormal platelet count independently predicted the risk for the composite outcome. Among 11,430 patients (75%) considered to be at low risk, 15 (0.13%) suffered pulmonary embolism, 22 (0.19%) bled, and 8 (0.07%) died. The C-statistic was 0.61 (95% confidence interval [CI], 0.57-0.65) for the decision to treat patients at home and 0.76 (95% CI, 0.72-0.79) for the score (P = .003). Net reclassification improvement was 41% (P < .001). Integrated discrimination improvement was 0.034 for the score and 0.015 for the clinical decision (P < .001).
  
  
  CONCLUSIONS
  Using 6 easily available variables, we identified outpatients with deep vein thrombosis at low risk for adverse events within the first week. These data may help to safely treat more patients at home. This score, however, should be validated.
authors.affiliation: Department of Internal Medicine, Complejo Hospitalario Universitario de Cartagena, Murcia, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Trujillo-Santos
authors.affiliation: Department of Angiology and Vascular Surgery, Complejo Asistencial de Salamanca, Salamanca, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Lozano
authors.affiliation: Department of Internal Medicine, Hospital de la Agencia Valenciana de Salud Vega Baja, Alicante, Spain.
authors.forename: Manuel Alejandro
authors.initials: MA
authors.lastname: Lorente
authors.affiliation: Department of Internal Medicine, Hospital de Montilla, Córdoba, Spain.
authors.forename: Dolores
authors.initials: D
authors.lastname: Adarraga
authors.affiliation: Department of Internal Medicine, University Hospital Plzen, Plzen, Czech Republic.
authors.forename: Jana
authors.initials: J
authors.lastname: Hirmerova
authors.affiliation: Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Jorge
authors.initials: J
authors.lastname: Del Toro
authors.affiliation: Department of Angiology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
authors.forename: Lucia
authors.initials: L
authors.lastname: Mazzolai
authors.affiliation: Department of Internal Medicine, Ospedale S. Maria della Misericordia, Udine, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Barillari
authors.affiliation: Department of Pneumonology, Hospital San Pedro, Logroño, La Rioja, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Barrón
authors.affiliation: Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain. Electronic address: mmonreal.germanstrias@gencat.cat.
authors.forename: Manuel
authors.initials: M
authors.lastname: Monreal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000592:standards* / Q000706:statistics & numerical data; D000925:Anticoagulants / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D010045:Outpatients / Q000706:statistics & numerical data; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods; D020246:Venous Thrombosis / Q000150:complications / Q000175:diagnosis / Q000628:therapy*
chemical_list: D000925:Anticoagulants
keywords: Anticoagulant therapy; Deep venous thrombosis; Home; Hospital; Outcome