title: A prognostic score to identify low-risk outpatients with acute deep vein thrombosis in the upper extremity.
abstract: BACKGROUND
  No studies have identified which patients with upper-extremity deep vein thrombosis (DVT) are at low risk for adverse events within the first week of therapy.
  
  
  METHODS
  We used data from Registro Informatizado de la Enfermedad TromboEmbólica to explore in patients with upper-extremity DVT a prognostic score that correctly identified patients with lower limb DVT at low risk for pulmonary embolism, major bleeding, or death within the first week.
  
  
  RESULTS
  As of December 2014, 1135 outpatients with upper-extremity DVT were recruited. Of these, 515 (45%) were treated at home. During the first week, three patients (0.26%) experienced pulmonary embolism, two (0.18%) had major bleeding, and four (0.35%) died. We assigned 1 point to patients with chronic heart failure, creatinine clearance levels 30-60 mL min(-1) , recent bleeding, abnormal platelet count, recent immobility, or cancer without metastases; 2 points to those with metastatic cancer; and 3 points to those with creatinine clearance levels < 30 mL min(-1) . Overall, 759 (67%) patients scored ≤ 1 point and were considered to be at low risk. The rate of the composite outcome within the first week was 0.26% (95% confidence interval [CI] 0.004-0.87) in patients at low risk and 1.86% (95% CI 0.81-3.68) in the remaining patients. C-statistics was 0.73 (95% CI 0.57-0.88). Net reclassification improvement was 22%, and integrated discrimination improvement was 0.0055.
  
  
  CONCLUSIONS
  Using six easily available variables, we identified outpatients with upper-extremity DVT at low risk for adverse events within the first week. These data may help to safely treat more patients at home.
authors.affiliation: Department of Internal Medicine, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.
authors.forename: V
authors.initials: V
authors.lastname: Rosa-Salazar
authors.affiliation: Department of Internal Medicine, Hospital General Universitario Santa Lucía, Murcia, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Trujillo-Santos
authors.affiliation: Department of Internal Medicine, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain.
authors.forename: J A
authors.initials: JA
authors.lastname: Díaz Peromingo
authors.affiliation: Department of Angiology, Ospedale Belcolle di Viterbo, Viterbo, Lazio, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Apollonio
authors.affiliation: Department of Internal Medicine, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas, Spain.
authors.forename: O
authors.initials: O
authors.lastname: Sanz
authors.affiliation: Department of Cardiovascular Medicine I, Charles University in Prague, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic.
authors.forename: R
authors.initials: R
authors.lastname: Malý
authors.affiliation: Department of Internal Medicine, Fundación Privada Hospital de Mollet, Mollet del Vallés, Spain.
authors.forename: F J
authors.initials: FJ
authors.lastname: Muñoz-Rodriguez
authors.affiliation: Department of Internal Medicine and Oncology Haematology, Hospital Dr. Patrocinio Peñuela Ruíz, Tachira, Venezuela.
authors.forename: J C
authors.initials: JC
authors.lastname: Serrano
authors.affiliation: Department of Internal Medicine, Hospital d'Olot I Comarcal de la Garrotxa, Garrotxa, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Soler
authors.affiliation: Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Universidad Católica de Murcia, Murcia, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Monreal
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects; D002170:Canada; D003661:Decision Support Techniques; D005060:Europe; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D011237:Predictive Value of Tests; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013020:South America; D013997:Time Factors; D016896:Treatment Outcome; D056824:Upper Extremity Deep Vein Thrombosis / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy
chemical_list: D000925:Anticoagulants
keywords: anticoagulant therapy; deep vein thrombosis; hospital; outcome; outpatients; upper extremity