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Meta-Analysis
. 2020 May;105(5):1436-1442.
doi: 10.3324/haematol.2019.222828. Epub 2019 Jul 4.

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 Wells  9 , Marc Carrier  9
Affiliations
Meta-Analysis

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 et al. Haematologica. 2020 May.

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 conclude 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).

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Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) Statement flow diagram.
Figure 2
Figure 2
Pooled recurrence rates of venous thromboembolism for the original Ottawa score. (A) Pooled recurrence rates of venous thromboembolism for the original Ottawa score in high-risk patients. (B) Pooled recurrence rates of venous thromboembolism for the original Ottawa score in low-risk patients.
Figure 3
Figure 3
Pooled recurrence rates of venous thromboembolism for the modified Ottawa score. (A) Pooled recurrence rates of venous thromboembolism for the modified Ottawa score in high-risk patients (B) Pooled recurrence rates of venous thromboembolism for the modified Ottawa score in intermediate-risk patients. (C) Pooled recurrence rates of venous thromboembolism for the modified Ottawa score in low-risk patients.
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