Background: Amongst patients with clinically suspected venous thromboembolism (VTE), about 20% are suspected recurrences. Diagnosing recurrent VTE may be challenging. Interpretation of diagnostic tests usually rely on clinical pre-test probability based on clinical decision rules (CDR). However, current CDR have not been validated in patients with a history of VTE.
Aims: To assess and refine the diagnostic algorithm in patients with suspected recurrent VTE. In the present analysis, we reported the accuracy and usefulness of Wells deep vein thrombosis (DVT), Wells pulmonary embolism (PE) and revised Geneva CDR in patients with a clinically suspected recurrent VTE.
Methods: We conducted an international prospective multicenter observational cohort study (PREDICTORS study) of outpatients with suspected VTE recurrence seen in the Emergency Departments or Thrombosis Clinics. Diagnostic management was performed based on usual clinical practices. Standardized case report forms of predictors and diagnostic tests were completed. Wells DVT score was computed in patients with suspected DVT. Wells PE and revised Geneva score were computed in patients with suspected PE. All patients were followed for 3 months and all suspected recurrent episodes during follow-up were independently adjudicated.
Results: 723 patients were included. Amongst patients with suspected DVT, 18/144 (12.5%) and 115/306 (37.6%) patients had a VTE recurrence at baseline and during follow-up in the Wells DVT unlikely and likely groups, respectively. Amongst patients with suspected PE, 14/90 (15.6%), 64/183 (35.0%) and 25/44 (56.8%) patients had a VTE recurrence in the Wells PE low, moderate and high-risk groups, respectively. Based on the revised Geneva score, VTE recurrence occurred in 4/50 (8.0%), 67/209 (32.1%) and 32/58 (55.2%) in the low, intermediate, and high-risk groups, respectively.
Conclusion(s): Wells DVT, Wells PE and revised Geneva CDR are able to risk stratify patients with suspected VTE recurrence. Further studies are needed to improve the yield of non-imaging diagnostic modalities.
To cite this abstract in AMA style:
Mai V, Klok F, Righini M, Schulman S, Thiruganasambandamoorthy V, Kahn S, Bates V, Pecarskie A, Kovacs M, Visser S, Shivakumar S, Tan M, Martens E, Rodger M, Scarvelis D, Delluc A, Girard P, Huisman M, Wells P, Le Gal G. Performance of clinical decision rules for venous thromboembolism in patients with a history of thrombosis [abstract]. https://abstracts.isth.org/abstract/performance-of-clinical-decision-rules-for-venous-thromboembolism-in-patients-with-a-history-of-thrombosis/. Accessed March 21, 2024.« Back to ISTH 2022 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/performance-of-clinical-decision-rules-for-venous-thromboembolism-in-patients-with-a-history-of-thrombosis/