Abstract 19875: IMPROVEDD Score: Addition of D-Dimer to the IMPROVE Score Improves Venous Thromboembolism Risk Stratification. An APEX Trial Substudy
Introduction: The IMPROVE score is used to stratify medical patients by their risk of venous thromboembolism (VTE). We explored whether the addition of D-dimer (DD) to create the IMPROVEDD Score would further improve risk stratification.
Methods: The association of the IMPROVE score and central DD ≥ 2x the upper limit of normal (ULN) with the 35 day risk of symptomatic deep vein thrombosis (DVT), non-fatal pulmonary embolism (PE), and VTE-related death was assessed in 7,513 hospitalized medically ill subjects randomized in the APEX Trial. Events were adjudicated by an independent committee. Based upon the results of the logistic regression, the IMPROVE score was modified by adding +2 points if DD + was ≥ 2x ULN and -2 points if DD - was < 2x ULN.
Results: In a multivariate model, DD was associated with the outcome (p<0.001) independent of the IMPROVE Score. Stratification of the IMPROVE score by DD + or - identified patients with high IMPROVE scores who were actually at much lower risk and patients with low IMPROVE scores who were actually at slightly higher risk (see curve). Integration of DD into the IMPROVE score to create the IMPROVEDD score increased the c-statistic from 0.58 to 0.63 and 53.3% of patients were reclassified into a risk category that differed by 5% from that of the IMPROVE Score.
Conclusions: D-dimer improves risk stratification and reclassifies patients when added to clinical risk factors in the IMPROVE Score.
Author Disclosures: C. Gibson: Research Grant; Significant; Angel Medical Corporation, Bayer Corp., CSL Behring, Ikaria, Inc., Janssen Pharmaceuticals, Johnson & Johnson Corporation, Portola Pharmaceuticals, Stealth Peptides, Inc., St. Jude Medical. Other Research Support; Modest; The Medicines Company. Consultant/Advisory Board; Modest; Boston Clinical Research Institute, Cardiovascular Research Foundation, Eli Lilly and Company, Gilead Sciences, Inc., The Medicines Company, Novo Nordisk, Pfizer, St. Jude Medical, Web MD. G. Chi: None. P. Jain: None. D. Szlosek: None. S.Z. Goldhaber: Research Grant; Modest; BiO2 Medical, Boehringer Ingelheim, Bristol-Myers Squibb, BTG EKOS, Daiichi-Sankyo, National Heart Lung and Blood Institute of the National Institutes of Health, Janssen, Thrombosis Research Group. Consultant/Advisory Board; Modest; Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi-Sankyo, Janssen, Bayer, Portola Pharmaceuticals. R.D. Hull: Research Grant; Modest; Portola Pharmaceuticals, Leo Pharma. A.F. Hernandez: Other Research Support; Modest; Amgen, AstraZeneca, Bayer, Merck, Novartis, Bristol Myers Squib, Portola Pharmaceuticals. Honoraria; Modest; AstraZeneca, Bayer, Novartis. S. Korjian: None. Y. Daaboul: None. R.A. Harrington: Research Grant; Modest; Portola Pharmaceuticals, CSL Behring, AstraZeneca, GlaxoSmithKline, Merck, Regado, The Medicines Company, Sanofi Aventis. Consultant/Advisory Board; Modest; Merck, The Medicines Company, Amgen, Gilead Sciences, MyoKardia, WebMD. Other; Modest; Scanadu, SignalPath, Element Science, Vida Health, Adverse Events. A.T. Cohen: None.
- © 2016 by American Heart Association, Inc.