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IMPROVE and Modified IMPROVE VTE Risk Scores

Description: https://johnsonfrancis.org/profession... Discussion of IMPROVE and modified IMPROVE VTE risk scores. IMPROVE score is a weighted VTE risk score designed for medically ill patients, which has been externally validated. Here are two relevant references. While formulating the IMPROVE VTE risk score, data from 15,156 medically ill patients were analyzed to find the cumulative incidence of VTE over a 3 month period after admission. Of the 184 patients who developed symptomatic VTE, 67 had lower extremity DVT and 76 had pulmonary embolism. Weightage given was 3 points for previous VTE, 2 points for known thrombophilia, 2 points each for lower limb paralysis and cancer, and one point each for immobilization, intensive or coronary care unit stay and age above 60 years. A score of 2 or more during hospitalization was associated with higher overall and VTE related mortality. MARINER trial of rivaroxaban for thromboprophylaxis after hospitalization for medical illness modified IMPROVE VTE score by including D-dimer values above twice the upper limit of normal. The trial enrolled patients if IMPROVE VTE score was 4 or more or a score 2 or 3 with elevated D-dimer. MAGELLAN study of rivaroxaban had shown efficacy but with excess bleeding. A subpopulation of the MAGELLEN study which had lower bleeding risk was retrospectively analyzed to check whether modified IMPROVE VTE model could identify a high risk VTE subgroup. That analysis showed that modified IMPROVE VTE score with an elevated D-dimer identified a subpopulation with about 3 fold higher VTE risk.