Riesgo de recurrencia tras retirada de la anticoagulación en pacientes con enfermedad tromboembólica venosa no provocada: validación externa del nomograma de Viena y del modelo predictivo DASH |
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Authors: | Samira Marín-Romero Teresa Elías-Hernández María Isabel Asensio-Cruz Rocío Ortega-Rivera Raquel Morillo-Guerrero Javier Toral Emilio Montero Verónica Sánchez Elena Arellano José María Sánchez-Díaz Macarena Real-Domínguez Remedios Otero-Candelera Luis Jara-Palomares |
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Affiliation: | 1. Unidad Médico Quirúrgica de Enfermedades Respiratorias, Hospital Universitario Virgen del Rocío, Sevilla, España;2. Servicio de Neumología, Hospital Ramón y Cajal, Madrid, España;3. Unidad de Urgencias y Emergencias, Hospital Universitario Virgen del Rocío, Sevilla, España;4. Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, España;5. Unidad Médico Quirúrgica de Enfermedades Respiratorias, Hospital Universitario Virgen del Rocío, Sevilla, España;6. Departamento de Medicina Preventiva y Salud Pública, Universidad de Málaga, Málaga, España;7. CIBERES, Instituto de Salud Carlos III, Madrid, España |
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Abstract: | IntroductionScales for predicting venous thromboembolism (VTE) recurrence are useful for deciding the duration of the anticoagulant treatment. Although there are several scales, the most appropriate for our setting has not been identified. For this reason, we aimed to validate the DASH prediction score and the Vienna nomogram at 12 months.MethodsThis was a retrospective study of unselected consecutive VTE patients seen between 2006 and 2014. We compared the ability of the DASH score and the Vienna nomogram to predict recurrences of VTE. The validation was performed by stratifying patients as low-risk or high-risk, according to each scale (discrimination) and comparing the observed recurrence with the expected rate (calibration).ResultsOf 353 patients evaluated, 195 were analyzed, with an average age of 53.5 ± 19 years. There were 21 recurrences in 1 year (10.8%, 95% CI: 6.8%-16%). According to the DASH score, 42% were classified as low risk, and the rate of VTE recurrence in this group was 4.9% (95% CI: 1.3%-12%) vs. the high-risk group that was 15% (95% CI: 9%-23%) (p <.05). According to the Vienna nomogram, 30% were classified as low risk, and the rate of VTE recurrence in the low risk group vs. the high risk group was 4.2% (95% CI:0.5%-14%) vs. 16.2% (95% CI: 9.9%-24.4%) (p <.05).ConclusionsOur study validates the DASH score and the Vienna nomogram in our population. The DASH prediction score may be the most advisable, both because of its simplicity and its ability to identify more low-risk patients than the Vienna nomogram (42% vs. 30%). |
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Keywords: | Autor para correspondencia Técnicas de apoyo a la toma de decisiones Tromboembolismo venoso Estudios de validación Embolismo pulmonar Trombosis venosa Decision support techniques Venous thromboembolism Validation studies (Publication type) Pulmonary embolism Venous thrombosis |
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