Model for calculating the risk of venous thrombosis
https://doi.org/10.15829/1560-4071-2019-5-37-43
Abstract
Aim. To develop a model for calculating the risk of venous thrombosis, taking into account the presence of known risk factors, comorbidity and congenital thrombophilia.
Material and methods. During the study (2015 to 2017), 79 patients with venous thrombosis were examined (36 men and 43 women, mean age — 56,76±15,570). The control group consisted of 83 patients and healthy volunteers without thrombosis at the moment and in history (35 men and 48 women, average age — 43,95±18,136). All individuals included in the study were analyzed for the presence of G1691A mutations in the factor V gene, G20210A in the prothrombin gene, C677T polymorphism in the 5,10-methylenetetrahydrofolate reductase gene, and polymorphism in the SERPINE1 gene of plasminogen activator inhibitor. Real-time polymerase chain reaction was used to identify mutations. To create a risk calculation model, a linear regression analysis was performed.
Results. We have developed a model for calculating the risk of venous thrombosis. The resulting formula showed high prognostic accuracy (the area under the ROC curve is 95,9%). For patients who do not have data on the presence of these mutations, a short version of the risk calculation model was developed (the area under the ROC curve is 94,6%).
Conclusion. We have developed a risk calculation model taking into account the presence of known risk factors, congenital thrombophilia and comorbidities. Thromboprophylaxis is necessary in >0,45 individual risk, which corresponds to a high risk of developing venous thrombosis. Patients who have not previously been diagnosed with thrombophilia and are in the middle risk group for venous thrombosis, according to a short version of the model, must be screened for congenital thrombophilia to clarify the risk.About the Authors
A. V. GolubRussian Federation
Moscow
Competing Interests:
nothing to declare
I. N. Bokarev
Russian Federation
Moscow
Competing Interests:
nothing to declare
L. V. Popova
Russian Federation
Competing Interests:
nothing to declare
A. N. Gerasimov
Russian Federation
Competing Interests:
nothing to declare
M. Z. Kanevskaya
Russian Federation
Moscow
Competing Interests:
nothing to declare
T. V. Khlevchuk
Russian Federation
Competing Interests:
nothing to declare
T. V. Kondratieva
Russian Federation
Competing Interests:
nothing to declare
M. B. Aksenova
Russian Federation
Competing Interests:
nothing to declare
L. V. Patrushev
Russian Federation
Moscow
Competing Interests:
nothing to declare
T. F. Kovalenko
Russian Federation
Moscow
Competing Interests:
nothing to declare
Yu. N. Belenkov
Russian Federation
Competing Interests:
nothing to declare
References
1. Raskob GE, Angchaisuksiri P, Blanko AN, et al. Thrombosis: a major contributor to the global disease burden. J Thromb Haemost. 2014;12:1580-90. doi:10.1111/jth.12698.
2. Jha AK, Larizgoitia I, Audera-Lopez C, et al. The global burden of unsafe medical care: analytic modeling of observational studies. BMJ Qual Saf 2013. 2013;22:809-15. doi:10.1136/bmjqs-2012-001748.
3. Benjamin EJ, Blaha MJ et al. Heart Disease and Stroke Statistics — 2017 Update: A Report from the American Heart Association. Circulation. 2017; 135:e 146-е603. doi: 10.1007/s12325-017-0618-4.
4. Milling TJ Jr, Frontera J. Exploring indications for the Use of direct oral anticoagulants and the associated risks of major bleeding. Am J Manag Care. 2017;23:S67-S80.
5. Andriyashkin AV, Andriyashkin VV, Arutyunov GP, et al. National Guidelines of diagnosis, treatment and prevention of venous thromboembolism. Phlebology. 2015;2:3-52. (In Russ.)
6. Heit JA, Ashrani A, Crusan DJ, et al. Reasons for the persistent incidence of venous thromboembolism. Thromb Haemost. 2017;2:390-400. doi:10.1160/TH16-07-0509.
7. Previtali E, Bucciarelli P, Passamonti SM, et al. Risk factors for venous and arterial thrombosis. Blood Transfus. 2011;9:120-38. doi:10.2450/2010.0066-10.
8. Bokarev IN, Popova LV. Modern problems of arterial and venous thrombosis. Practical medicine. 2014;6:13-7. (In Russ.) Бокарев И. Н., Попова Л. В. Современные проблемы тромбозов артерий и вен. Практическая медицина. 2014; 6:13-7.
9. Naghavi M, Wang H, Lozano R, et al. Global, regional, and national age-sex specific allcause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study. Lancet. 2015;385:117-71. doi:10.1016/S0140-6736(14)61682-2.
10. Stuck AK, Spirk D, Schaudt J, et al. Risk assessment models for venous thromboembolism in acutely ill medical patients. A systematic review. Thromb Haemost. 2017;4:801-8. doi:10.1160/TH16-08-0631.
11. Camden R, Ludwig S. Prophylaxis against venous thromboembolism in hospitalized medically ill patients: Update and practical approach. Am J Health Syst Pharm. 2014;11:909-17. doi:10.2146/ajhp130475.
12. Spyropoulos AC, McGinn T, Khorana AA. The use of weighted and scored risk assessment models for venous thromboembolism. Thromb Haemost. 2012;108:1072-6. doi:10.1160/TH12-07-0508.
13. Barbar S, Noventa F, Rossetto V, et al. A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: the Padua Prediction Score. J Thromb Haemost. 2010;8:2450-7. doi:10.1111/j.1538-7836.2010.04044.x.
14. Spyropoulos AC, Anderson FA Jr, FitzGerald G. Predictive and associative models to identify hospitalized medical patients at risk for VTE. Chest. 2011;3:706-14. doi:10.1378/chest.10-1944.
15. Rossetto V, Barbar S, Vedovetto V, et al. Physicians' compliance with the Padua Prediction Score for preventing venous thromboembolism among hospitalized medical patients. J Thromb Haemost. 2013;11:1428-30. doi:10.1111/jth.12258.
Review
For citations:
Golub A.V., Bokarev I.N., Popova L.V., Gerasimov A.N., Kanevskaya M.Z., Khlevchuk T.V., Kondratieva T.V., Aksenova M.B., Patrushev L.V., Kovalenko T.F., Belenkov Yu.N. Model for calculating the risk of venous thrombosis. Russian Journal of Cardiology. 2019;(5):37-43. https://doi.org/10.15829/1560-4071-2019-5-37-43