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    Ferrata Storti Foundation
Haematologica 2020 Volume 105(5):1436-1442
Coagulation & its Disorders
Accuracy of the Ottawa score in risk stratification of recurrent venous thromboembolism in patients with cancer-associated venous thromboembolism: a systematic review and meta-analysis
Aurélien Delluc,1 Sébastien Miranda,2 Paul den Exter,3 Martha Louzada,4 Adriano Alatri,5 Shin Ahn,6 Manuel Monreal,7 Alok Khorana,8
Menno V. Huisman,3 Philip S. Wells1 and Marc Carrier1
1Department of Medicine, Ottawa Hospital Research Institute at the University of Ottawa, Ottowa, Ontario, Canada; 2Normandie University, UNIROUEN, INSERM U1096 and Rouen University Hospital, Department of Internal Medicine, Vascular and Thrombosis Unit, F 76000 Rouen, France; 3Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands; 4Department of Medicine, Division of Hematology, University of Western Ontario, London, Ontario, Canada; 5Division of Angiology, Lausanne University Hospital, Lausanne, Switzerland; 6Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; 7Department of Internal Medicine. Hospital Universitari Germans Trias i Pujol, Badalona, Spain and 8Cleveland Clinic-Taussig Cancer Center, Cleveland, OH, USA
  ABSTRACT
In patients with cancer-associated venous thromboembolism, knowledge of the estimated rate of recurrent events is important for clinical decision- making regarding anticoagulant therapy. The Ottawa score is a clinical prediction rule designed for this purpose, stratifying patients according to their risk of recurrent venous thromboembolism during the first six months of anticoagulation. We conducted a systematic review and meta-analysis of studies validating either the Ottawa score in its original or modified versions. Two investigators independently reviewed the relevant articles published from 1st June 2012 to 15th December 2018 and indexed in MEDLINE and EMBASE. Nine eligible studies were identified; these included a total of 14,963 patients. The original score classified 49.3% of the patients as high- risk, with a sensitivity of 0.7 [95% confidence interval (CI): 0.6-0.8], a 6- month pooled rate of recurrent venous thromboembolism of 18.6% (95%CI: 13.9-23.9). In the low-risk group, the recurrence rate was 7.4% (95%CI: 3.4-12.5). The modified score classified 19.8% of the patients as low-risk, with a sensitivity of 0.9 (95%CI: 0.4-1.0) and a 6-month pooled rate of recurrent venous thromboembolism of 2.2% (95%CI: 1.6-2.9). In the high-risk group, recurrence rate was 10.2% (95%CI: 6.4-14.6). Limitations of our analysis included type and dosing of anticoagulant therapy. We con- clude that new therapeutic strategies are needed in patients at high risk for recurrent cancer-associated venous thromboembolism. Low-risk patients, as per the modified score, could be good candidates for oral anticoagulation. (This systematic review was registered with the International Prospective Registry of Systematic Reviews as: PROSPERO CRD42018099506).
Introduction
Cancer is one of the most frequent risk factors for venous thromboembolism (VTE) and for VTE recurrence while on anticoagulation.1,2 In patients with VTE and cancer, the rate of recurrent VTE despite anticoagulation can reach up to 20% after six months of therapy, but this rate highly depends on several patient and cancer characteristics.3 For example, age, residual thrombosis, previous history of VTE, sur- gical procedures within three months prior to VTE, cancer stage, and the site and
  Correspondence:
AURÉLIEN DELLUC
adelluc@toh.ca
Received: March 27, 2019. Accepted: June 28, 2019. Pre-published: July 4, 2019.
doi:10.3324/haematol.2019.222828
Check the online version for the most updated information on this article, online supplements, and information on authorship & disclosures: www.haematologica.org/content/105/5/1436
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