A new pre-test probability score for diagnosis of deep vein thrombosis in patients before surgery. Issue 5 (May 2022)

• Record Type: Journal Article
• Authors: Hamamoto, Yuki; Tokushige, Akihiro; Toshinori, Yuasa; Ikeda, Yoshiyuki; Horizoe, Yoshihisa; Yasuda, Hisayo; Kubozono, Takuro; Ohishi, Mitsuru
• Is Part Of: Journal of cardiology. Volume 79:Issue 5(2022)
• Page Start: 664
• Page End: 670
• Publication Date: 2022-05
• Subjects: DVT deep vein thrombosis -- VTE venous thromboembolism -- PTE pulmonary thromboembolism -- WLUS whole-leg ultrasonography -- BMI body mass index -- WBC white blood cell count -- Hb hemoglobin -- Plt platelet count -- eGFR estimated glomerular filtration rate -- AST aspartate aminotransferase -- ALT alanine aminotransferase -- DIC disseminated intravascular coagulation; Before surgery -- D-dimer -- Deep vein thrombosis -- Kagoshima-DVT score -- Pre-test probability score -- Whole leg ultrasonography; Cardiology -- Periodicals; 616.12
• DOI: 10.1016/j.jjcc.2021.11.025
• Languages: English
• ISSNs: 0914-5087

Abstract

Highlights: The pre-test probability score for predicting deep vein thrombosis before surgery Detecting preoperative asymptomatic deep vein thrombosis The scores were used with objective variables only Stratifying into high-, intermediate-, and low-probability groups Abstract: Background: Venous thromboembolism is a serious perioperative complication. We developed a new pre-test probability score for predicting deep vein thrombosis (DVT) before surgery. Methods: Whole leg ultrasonography was performed on 973 inpatients and outpatients with suspected DVT based on a preoperative D-dimer cut-off value of ≥ 1 μg/ml. We allocated two-thirds (n = 651) of the study participants to a derivation cohort and one-third (n = 322) to a validation cohort. The pre-test probability model was developed from the derivation cohort data. Results: The pre-test probability model for DVT assigned 2 points to D-dimer ≥ 1.5 μg/mL and 1 point each to age ≥ 60 years, female sex, ongoing glucocorticoid therapy, prolonged immobility, and cancer with high risk of DVT. The area under the curve of the pre-test probability score was 0.72 and 0.70 in the derivation and validation cohorts, respectively. The rates of DVT according to pre-test probability scores in the derivation and validation cohorts were 7% and 6% in the low (score = 0-2), 23% and 22% in the intermediate (score = 3-4), and 47% and 50% in the high probability group (score ≥ 5), respectively ( p < 0.0001). Conclusions: The pre-test probability score (Kagoshima-DVT score) was helpful in detecting preoperative DVT in both inpatients and outpatients. We identified low probability group to reduce whole-leg ultrasonography and high probability group to detect more DVT before surgery. Graphical abstract: Image, graphical abstract