Top

Supportive Care in Cancer

Published in:

01-08-2013 | Original Article

Validation of the clinical prediction rule for recurrent venous thromboembolism in cancer patients: the Ottawa score

Authors: Shin Ahn, Kyung Soo Lim, Yoon-Seon Lee, Jae-Lyun Lee

Published in: Supportive Care in Cancer | Issue 8/2013

Abstract

Purpose

Recently, a clinical prediction rule for recurrent venous thromboembolism (VTE) in cancer patients, named Ottawa score, was derived to individualize treatments with different intensities. It is composed of four variables including sex, primary tumor site, tumor stage, and prior history of VTE. The objective of this study was to validate the Ottawa score in an independent patient population in a tertiary hospital in Korea.

Methods

Medical records of consecutive adult patients (>18 years) with active malignancy and newly diagnosed VTE from January 1, 2006 to December 31, 2010 were analyzed. Using the same definition of predictor variables in the original derivation study, patients were divided into low (score ≤0) and high (score ≥1) risk groups for recurrent VTE, and their actual recurrence rate were analyzed.

Results

Of the 546 patients with newly diagnosed VTE, 99 (18.1 %) had recurrent VTE during the follow-up period. In the low-risk group, 34 (13.2 %) had recurrence, compared to 65 (22.4 %) in the high-risk group. Ottawa score’s performance showed 66 % sensitivity, 50 % specificity, 22 % positive predictive value, and 87 % negative predictive value in our validation cohort.

Conclusion

We were not able to accurately ascertain the relevance of the Ottawa score in our validation cohort. Future validation studies, including a more diverse patient population with different cancer predominance, are warranted.

Blom JW, Doggen CJ, Osanto S, Rosendaal FR (2005) Malignancies, prothrombotic mutations, and the risk of venous thrombosis. JAMA 293:715–722PubMedCrossRef

Silverstein MD, Heit JA, Mohr DN, Petterson TM, O’Fallon WM, Melton LJ 3rd (1998) Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch Intern Med 158:585–593PubMedCrossRef

Chew HK, Wun T, Harvey D, Zhou H, White RH (2006) Incidence of venous thromboembolism and its effect on survival among patients with common cancers. Arch Intern Med 166:458–464PubMed

Sorensen HT, Mellemkjaer L, Olsen JH, Baron JA (2000) Prognosis of cancers associated with venous thromboembolism. N Engl J Med 343:1846–1850PubMedCrossRef

Prandoni P, Lensing AW, Piccioli A, Bernardi E, Simioni P, Girolami B, Marchiori A, Sabbion P, Prins MH, Noventa F, Girolami A (2002) Recurrent venous thromboembolism and bleeding complications during anticoagulant treatment in patients with cancer and venous thrombosis. Blood 100:3484–3488PubMedCrossRef

Wells PS (2001) Outpatient treatment of patients with deep-vein thrombosis or pulmonary embolism. Curr Opin Pulm Med 7:360–364PubMedCrossRef

Wells PS, Kovacs MJ, Bormanis J, Forgie MA, Goudie D, Morrow B, Kovacs J (1998) Expanding eligibility for outpatient treatment of deep venous thrombosis and pulmonary embolism with low-molecular-weight heparin: a comparison of patient self-injection with homecare injection. Arch Intern Med 158:1809–1812PubMedCrossRef

Hull RD, Pineo GF, Brant RF, Mah AF, Burke N, Dear R, Wong T, Cook R, Solymoss S, Poon MC, Raskob G (2006) Long-term low-molecular-weight heparin versus usual care in proximal-vein thrombosis patients with cancer. Am J Med 119:1062–1072PubMedCrossRef

Deitcher SR, Kessler CM, Merli G, Rigas JR, Lyons RM, Fareed J (2006) Secondary prevention of venous thromboembolic events in patients with active cancer: enoxaparin alone versus initial enoxaparin followed by warfarin for a 180-day period. Clin Appl Thromb Hemost 12:389–396PubMedCrossRef

10.

Lee AY, Levine MN, Baker RI, Bowden C, Kakkar AK, Prins M, Rickles FR, Julian JA, Haley S, Kovacs MJ, Gent M (2003) Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med 349:146–153PubMedCrossRef

11.

Meyer G, Marjanovic Z, Valcke J, Lorcerie B, Gruel Y, Solal-Celigny P, Le Maignan C, Extra JM, Cottu P, Farge D (2002) Comparison of low-molecular-weight heparin and warfarin for the secondary prevention of venous thromboembolism in patients with cancer: a randomized controlled study. Arch Intern Med 162:1729–1735PubMedCrossRef

12.

Hull RD, Pineo GF, Brant RF, Mah AF, Burke N, Dear R, Wong T, Cook R, Solymoss S, Poon MC, Raskob G (2007) Self-managed long-term low-molecular-weight heparin therapy: the balance of benefits and harms. Am J Med 120:72–82PubMedCrossRef

13.

Louzada ML, Carrier M, Lazo-Langner A, Dao V, Kovacs MJ, Ramsay TO, Rodger MA, Zhang J, Lee AY, Meyer G, Wells PS (2012) Development of a clinical prediction rule for risk stratification of recurrent venous thromboembolism in patients with cancer-associated venous thromboembolism. Circulation 126:448–454PubMedCrossRef

14.

Monreal M, Zacharski L, Jimenez JA, Roncales J, Vilaseca B (2004) Fixed-dose low-molecular-weight heparin for secondary prevention of venous thromboembolism in patients with disseminated cancer: a prospective cohort study. J Thromb Haemost 2:1311–1315PubMedCrossRef

15.

Trujillo-Santos J, Nieto JA, Tiberio G, Piccioli A, Di Micco P, Prandoni P, Monreal M (2008) Predicting recurrences or major bleeding in cancer patients with venous thromboembolism. Findings from the RIETE Registry. Thromb Haemost 100:435–439PubMed

16.

Lee J, Demissie K, Lu SE, Rhoads GG (2007) Cancer incidence among Korean-American immigrants in the United States and native Koreans in South Korea. Cancer Control 14:78–85PubMed

17.

Louzada ML, Majeed H, Dao V, Wells PS (2011) Risk of recurrent venous thromboembolism according to malignancy characteristics in patients with cancer-associated thrombosis: a systematic review of observational and intervention studies. Blood Coagul Fibrinolysis 22:86–91PubMedCrossRef

Title: Validation of the clinical prediction rule for recurrent venous thromboembolism in cancer patients: the Ottawa score
Authors: Shin Ahn
Kyung Soo Lim
Yoon-Seon Lee
Jae-Lyun Lee
Publication date: 01-08-2013
Publisher: Springer Berlin Heidelberg
Published in: Supportive Care in Cancer / Issue 8/2013
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-013-1792-9

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 8/2013

Associations of interleukin-6 with vegetative but not affective depressive symptoms in terminally ill cancer patients

Predictors of acute adverse events from rapid rituximab infusion

Dosimetric and clinical impact of 3D vs. 2D planning in palliative radiotherapy for bone metastases

Reducing disparity in outcomes for immigrants with cancer: a qualitative assessment of the feasibility and acceptability of a culturally targeted telephone-based supportive care intervention

Adding procalcitonin to the MASCC risk-index score could improve risk stratification of patients with febrile neutropenia

The poor use of methadone in Italian hospices

Keynote webinar | Spotlight on antibody–drug conjugates in cancer