February 2014
J Pain Symptom Manage. 2013 Dec 9. [Epub ahead of print]
Johnson MJ, McMillan B, Fairhurst C, Gabe R, Ward J, Wiseman J, Pollington B, Noble SI
This retrospective case-note study investigated the relationship between risk of venous thromboembolism and symptom development. Consecutive admission data was collected from seven U.K. hospices (n=1164). Venous thromboembolism risk was assessed using the Pan Birmingham Cancer Network palliative-modified Thromboembolic Risk Factors (THRIFT) criteria and if there was a temporary elevated risk of venous thromboembolism. Symptoms and signs of venous thromboembolism were documented during admission. THRIFT risk was high in 13%, medium in 83%, and low in 4%; a temporary elevated risk was identified in 24%. In the group deemed to be most clinically relevant (i.e. those who were not anticoagulated, had no contraindication and where primary thromboprophylaxis could have been prescribed; n = 528), 21% people with a temporary elevated risk of venous thromboembolism had symptoms as opposed to 9% of those who did not have a temporary elevated risk. A moderate/high THRIFT score had a sensitivity of 98% and specificity of 6%. The temporary elevated risk assessment had a sensitivity of 42% and specificity of 79%. The authors concluded that temporary elevated risk alone is simpler to use and may be more useful in this population than the THRIFT, but still has limitations regarding ability to predict symptoms.