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. 2022 Jun 28;11(13):3729.
doi: 10.3390/jcm11133729.

The Ottawa Score Performs Poorly to Identify Cancer Patients at High Risk of Recurrent Venous Thromboembolism: Insights from the TROPIQUE Study and Updated Meta-Analysis

Corinne Frere  1 , Benjamin Crichi  2 , Clémentine Wahl  1 , Elodie Lesteven  1 , Jérôme Connault  3 , Cécile Durant  3 , Jose Antonio Rueda-Camino  4 , Alexandra Yannoutos  5 , Okba Bensaoula  6 , Christine Le Maignan  2 , Zora Marjanovic  7 , Dominique Farge  2   8
Affiliations

The Ottawa Score Performs Poorly to Identify Cancer Patients at High Risk of Recurrent Venous Thromboembolism: Insights from the TROPIQUE Study and Updated Meta-Analysis

Corinne Frere et al. J Clin Med. .

Abstract

The Ottawa score (OS) for predicting the risk of recurrent venous thromboembolism (VTE) in cancer patients with VTE may help to guide anticoagulant treatment decisions that will optimize benefit-risk ratios. However, data on its reliability are conflicting. We applied the OS to all cancer patients with VTE enrolled in the prospective multicenter TROPIQUE study who received low-molecular-weight heparin over a 6-month period. Of 409 patients, 171 (41.8%) had a high-risk OS. The 6-month cumulative incidence of recurrent VTE was 7.8% (95%CI 4.2-14.8) in the high-risk OS group versus 4.8% (95%CI 2.6-8.9) in the low-risk OS group (SHR 1.47; 95%CI 0.24-8.55). The Area Under the Receiver Operating Characteristic curve (AUROC) of the OS in identifying patients who developed recurrent VTE was 0.53 (95%CI 0.38-0.65), and its accuracy was 57.9%. Among individual variables included in the OS, only prior VTE was significantly associated with the 6-month risk of recurrent VTE (SHR 4.39; 95% CI 1.13-17.04). When pooling data from all studies evaluating this score for predicting VTE recurrence in cancer patients (7 studies, 3413 patients), the OS estimated pooled AUROC was 0.59 (95%CI 0.56-0.62), and its accuracy was 55.7%. The present findings do not support the use of the OS to assess the risk of recurrent VTE in cancer patients.

Keywords: anticoagulants; cancer; recurrence; score; venous thromboembolism.

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Conflict of interest statement

C.F. reports receiving honoraria for participating as a speaker at satellite symposia organized by Bayer, Bristol Myers Squibb, and LEO Pharma; other authors have nothing to disclose.

Figures

Figure 1
Figure 1
Six-month cumulative incidence of recurrent venous thromboembolism in patients with high- (≥1) and low-risk Ottawa score (≤0).
Figure 2
Figure 2
Receiver operating curve for the Ottawa score for prediction of recurrent venous thromboembolism in the TROPIQUE cohort.
Figure 3
Figure 3
Pooled rates of recurrent venous thromboembolism for the original Ottawa score: (A) High-risk patients, (B) Low-risk patients.
See this image and copyright information in PMC

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