Accuracy of the Ottawa score in risk stratification of recurrent venous thromboembolism in patients with cancer-associated venous thromboembolism: a systematic review and meta-analysis
Por:
Delluc, A, Miranda, S, den Exter, P, Louzada, M, Alatri, A, Ahn, S, Monreal, M, Khorana, A, Huisman, MV, Wells, PS and Carrier, M
Publicada:
1 may 2020
Ahead of Print:
4 jul 2019
Resumen:
In patients with cancer-associated venous thromboembolism, knowledge of the estimated rate of recurrent events is important for clinical decision-making regarding anticoagulant therapy. The Ottawa score is a clinical prediction rule designed for this purpose, stratifying patients according to their risk of recurrent venous thromboembolism during the first six months of anticoagulation. We conducted a systematic review and meta-analysis of studies validating either the Ottawa score in its original or modified versions. Two investigators independently reviewed the relevant articles published from 1st June 2012 to 15th December 2018 and indexed in MEDLINE and EMBASE. Nine eligible studies were identified; these included a total of 14,963 patients. The original score classified 49.3% of the patients as high-risk, with a sensitivity of 0.7 [95% confidence interval (CI): 0.6-0.8], a 6-month pooled rate of recurrent venous thromboembolism of 18.6% (95%CI: 13.9-23.9). In the low-risk group, the recurrence rate was 7.4% (95%CI: 3.4-12.5). The modified score classified 19.8% of the patients as low-risk, with a sensitivity of 0.9 (95%CI: 0.4-1.0) and a 6-month pooled rate of recurrent venous thromboembolism of 2.2% (95%CI: 1.6-2.9). In the high-risk group, recurrence rate was 10.2% (95%CI: 6.4-14.6). Limitations of our analysis included type and dosing of anticoagulant therapy. We conclude that new therapeutic strategies are needed in patients at high risk for recurrent cancer-associated venous thromboembolism. Low-risk patients, as per the modified score, could be good candidates for oral anticoagulation.
Filiaciones:
Delluc, A:
Univ Ottawa, Dept Med, Ottawa Hosp Res Inst, Ottawa, ON, Canada
Miranda, S:
Normandie Univ, UNIROUEN, INSERM, U1096, F-76000 Rouen, France
Rouen Univ Hosp, Dept Internal Med, Vasc & Thrombosis Unit, F-76000 Rouen, France
den Exter, P:
Leiden Univ, Dept Thrombosis & Hemostasis, Med Ctr, Leiden, Netherlands
Louzada, M:
Univ Western Ontario, Dept Med, Div Hematol, London, ON, Canada
Alatri, A:
Lausanne Univ Hosp, Div Angiol, Lausanne, Switzerland
Ahn, S:
Univ Ulsan, Asan Med Ctr, Dept Emergency Med, Coll Med, Seoul, South Korea
:
Hosp Badalona Germans Trias & Pujol, Dept Internal Med, Badalona, Spain
Khorana, A:
Cleveland Clin, Taussig Canc Ctr, Cleveland, OH 44106 USA
Huisman, MV:
Leiden Univ, Dept Thrombosis & Hemostasis, Med Ctr, Leiden, Netherlands
Wells, PS:
Univ Ottawa, Dept Med, Ottawa Hosp Res Inst, Ottawa, ON, Canada
Carrier, M:
Univ Ottawa, Dept Med, Ottawa Hosp Res Inst, Ottawa, ON, Canada
gold, Green Published
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