Impact of Thrombophilia Screening On Venous Thromboembolism Management Practices
Bibliographic record
Abstract
Abstract Abstract 1158 BACKGROUND In patients with idiopathic venous thromboembolism (VTE) thrombophilia screening (TS) is usually done with the aim of helping to guide long term management. Since 2008 our center has modified clinical practice and decisions on long term management have been based on the findings of the REVERSE study (Rodger et al., CMAJ 2008), which stratifies recurrence risk based on clinical and laboratory risk factors excluding thrombophilia (TPh). We therefore aimed to study the current impact of TS on VTE management practices, particularly since the advent of the REVERSE study. METHODS We conducted a single-center, retrospective cohort study of all patients with objectively confirmed VTE who were consecutively referred to our thrombosis clinic from January 1st, 1999 to December 31st 2011. Patients were excluded if the VTE was due to hospital stay, pregnancy, immobility, or surgery. The primary outcome was the decision of maintaining anticoagulation (AC) beyond the initial planned period (6 months after VTE) based on TS. Secondary outcomes included decision of maintaining AC based on REVERSE criteria or other reasons, and incidence of recurrent VTE. Major TPh was defined as any of: confirmed antithrombin, protein S or protein C deficiencies, persistently positive anticardiolipin antibodies or lupus anticoagulant, or homozygote/compound heterozygote carriers of the Factor V Leiden or G20210A prothrombin gene variant. According to the year of diagnosis patients were divided in groups before and after 2008. Groups were compared using χ2 or Fisher's exact tests, as appropriate. Survival data was analyzed using the Kaplan-Meier method and Cox regression analysis. RESULTS We included 1033 out of 1100 eligible patients. Mean age was 55.59 years (SD 17.96), the mean length of follow up was 55.5 months (range 0 to 229), and 48.11% were female. Of 880 (85.2%) known family histories, 12.39% were positive for a previous VTE. Results for TPh testing and primary and secondary outcomes are shown in Tables 1 and 2. Overall, the proportion of patients continuing AC based on TS was small. After 2008, the majority of patients continuing OAT were based on REVERSE criteria. Compared to patients without TPh and after adjusting for AC continuation beyond 6 months, the presence of non-major TPh resulted in a modest increase in VTE recurrence risk (OR 1.71, 95% CI 1.20–2.44; P<0.01) whereas the presence of major TPh did not (OR 0.55, 95% CI 0.19–2.44; P=0.27). Continuation of AC beyond the initial planned period resulted in 75% reduction in VTE recurrence risk (OR 0.25, 95%CI 0.12–0.55; P<0.001). CONCLUSIONS The impact of TPh on VTE recurrence is small and the proportion of patients in whom TS results in long term AC is low. Furthermore, current decisions of AC duration are based on clinical criteria and might impact the risk of VTE recurrence to a greater extent than TS. Although at present TS seems to have a less preponderant role in management decisions, it might be of value for counseling purposes. Disclosures: Lazo-Langner: Pfizer: Honoraria; Leo Pharma: Honoraria.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.009 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".