TY - JOUR
T1 - Predictors of active cancer thromboembolic outcomes
T2 - RIETE experience of the Khorana score in cancer-associated thrombosis
AU - RIETE Investigators
AU - Tafur, Alfonso J.
AU - Caprini, Joseph A.
AU - Cote, Lauren
AU - Trujillo-Santos, Javier
AU - del Toro, Jorge
AU - Garcia-Bragado, Fernando
AU - Tolosa, Carles
AU - Barillari, Giovanni
AU - Visona, Adriana
AU - Monreal, Manuel
AU - Adarraga, M. D.
AU - Aibar, M. A.
AU - Alfonso, M.
AU - Arcelus, J. I.
AU - Ballaz, A.
AU - Barba, R.
AU - Barrón, M.
AU - Barŕn-Andrés, B.
AU - Bascuñana, J.
AU - Blanco-Molina, A.
AU - Cañas, I.
AU - Chic, N.
AU - del Pozo, R.
AU - Díaz-Pedroche, M. C.
AU - Díaz-Peromingo, J. A.
AU - Falgá, C.
AU - Fernández-Aracil, C.
AU - Fernández-Capitán, C.
AU - Fidalgo, M. A.
AU - Font, C.
AU - Font, L.
AU - Gallego, P.
AU - García, I.
AU - García, M. A.
AU - García-Ródenas, M.
AU - Gavín, O.
AU - Gómez, C.
AU - Gómez, V.
AU - González, J.
AU - Grau, E.
AU - Grimón, A.
AU - Guijarro, R.
AU - Guirado, L.
AU - Gutiérrez, J.
AU - Hernández-Comes, G.
AU - Hernández-Blasco, L.
AU - Jara-Palomares, L.
AU - Jaras, M. J.
AU - Jiménez, D.
AU - Jiménez, J.
N1 - Publisher Copyright:
© Schattauer 2017.
PY - 2017/1/1
Y1 - 2017/1/1
N2 - Even though the Khorana risk score (KRS) has been validated to predict against the development of VTE among patients with cancer, it has a low positive predictive value. It is also unknown whether the score predicts outcomes in patients with cancer with established VTE. We selected a cohort of patients with active cancer from the RIETE (Registro Informatizado Enfermedad TromboEmbolica) registry to assess the prognostic value of the KRS at inception in predicting the likelihood of VTE recurrences, major bleeding and mortality during the course of anticoagulant therapy. We analysed 7948 consecutive patients with cancer-associated VTE. Of these, 2253 (28 %) scored 0 points, 4550 (57 %) 1-2 points and 1145 (14 %) scored ≥points. During the course of anticoagulation, amongst patient with low, moderate and high risk KRS, the rate of VTE recurrences was of 6.21 (95 %CI: 4.99-7.63), 11.2 (95 %CI: 9.91-12.7) and 19.4 (95 %CI: 15.4-24.1) events per 100 patient-years; the rate of major bleeding of 5.24 (95 %CI: 4.13-6.56), 10.3 (95 %CI: 9.02-11.7) and 19.4 (95 %CI: 15.4-24.1) bleeds per 100 patient-years and the mortality rate of 25.3 (95 %CI: 22.8-28.0), 58.5 (95 %CI: 55.5-61.7) and 120 (95 %CI: 110-131) deaths per 100 patient-years, respectively. The C-statistic was 0.53 (0.50-0.56) for recurrent VTE, 0.56 (95 %CI: 0.54-0.59) for major bleeding and 0.54 (95 %CI: 0.52-0.56) for death. In conclusion, most VTEs occur in patients with low or moderate risk scores. The KRS did not accurately predict VTE recurrence, major bleeding, or mortality among patients with cancer-associated thrombosis.
AB - Even though the Khorana risk score (KRS) has been validated to predict against the development of VTE among patients with cancer, it has a low positive predictive value. It is also unknown whether the score predicts outcomes in patients with cancer with established VTE. We selected a cohort of patients with active cancer from the RIETE (Registro Informatizado Enfermedad TromboEmbolica) registry to assess the prognostic value of the KRS at inception in predicting the likelihood of VTE recurrences, major bleeding and mortality during the course of anticoagulant therapy. We analysed 7948 consecutive patients with cancer-associated VTE. Of these, 2253 (28 %) scored 0 points, 4550 (57 %) 1-2 points and 1145 (14 %) scored ≥points. During the course of anticoagulation, amongst patient with low, moderate and high risk KRS, the rate of VTE recurrences was of 6.21 (95 %CI: 4.99-7.63), 11.2 (95 %CI: 9.91-12.7) and 19.4 (95 %CI: 15.4-24.1) events per 100 patient-years; the rate of major bleeding of 5.24 (95 %CI: 4.13-6.56), 10.3 (95 %CI: 9.02-11.7) and 19.4 (95 %CI: 15.4-24.1) bleeds per 100 patient-years and the mortality rate of 25.3 (95 %CI: 22.8-28.0), 58.5 (95 %CI: 55.5-61.7) and 120 (95 %CI: 110-131) deaths per 100 patient-years, respectively. The C-statistic was 0.53 (0.50-0.56) for recurrent VTE, 0.56 (95 %CI: 0.54-0.59) for major bleeding and 0.54 (95 %CI: 0.52-0.56) for death. In conclusion, most VTEs occur in patients with low or moderate risk scores. The KRS did not accurately predict VTE recurrence, major bleeding, or mortality among patients with cancer-associated thrombosis.
KW - Cancer
KW - Mortality
KW - Prediction
KW - Recurrences
KW - Venous thrombosis
UR - http://www.scopus.com/inward/record.url?scp=85020257480&partnerID=8YFLogxK
U2 - 10.1160/TH16-11-0840
DO - 10.1160/TH16-11-0840
M3 - Article
C2 - 28276571
AN - SCOPUS:85020257480
SN - 0340-6245
VL - 117
SP - 1192
EP - 1198
JO - Thrombosis and Haemostasis
JF - Thrombosis and Haemostasis
IS - 6
ER -