. 2025 Aug 12;9(15):3837-3844.

doi: 10.1182/bloodadvances.2024015515.

The CLUE postsurgery VTE risk instrument for abdominal and pelvic surgery: validation of patient risk factor component

Kari A O Tikkinen^{1

2

3

4}, Deborah M Siegal^{5

6}, P J Devereaux^{4

7

8

9}, Sara V Tornberg², Flavia K Borges^{4

7

8}, Sandra Ofori⁷, Jehonathan Pinthus^{10

11}, Bobby Shayegan^{10

12}, Lauri I Lavikainen¹; CLUE Post-Surgery VTE Risk Instrument Group; Gordon H Guyatt^{4

7}, Pavel S Roshanov^{8

9

13

14}

Collaborators, Affiliations

Collaborators

CLUE Post-Surgery VTE Risk Instrument Group:
Riikka L Aaltonen, Arnav Agarwal, Chika Agbassi, Kaisa Ahopelto, Bassel Ali, Karoliina M Aro, Ines Beilmann-Lehtonen, Marco H Blanker, Kostiantyn Bolsunovskyi, Rufus Cartwright, Jovita L Cárdenas, Samantha Craigie, Rachel J Couban, Jaana Elberkennou, Leyla Eryuzlu, Päivi J Galambosi, Herney A Garcia-Perdomo, Fang Zhou Ge, Johanna Geraci, Michael K Gould, Huda A Gomaa, Rachel Gutschon, Alex L E Halme, Jari Haukka, Maha Imam, Nofisat Ismaila, Matthew L Izett-Kay, Ilkka E J Kalliala, Paul J Karanicolas, Denise Kam, Nadina Khamani, Tuomas P Kilpeläinen, Antti J Kivelä, Kirsi M Joronen, Hanna Lampela, Yung Lee, Anna L Luomaranta, Anne K Mattila, Giacomo Novara, Richard Naspro, Taina P Nykänen, Sanna M Oksjoki, Sanjay Pandanaboyana, Negar Pourjamal, Chathura B B Ratnayake, Aleksi R Raudasoja, Ville J Sallinen, Per Morten Sandset, Reed A Siemieniuk, Tino Singh, Riikka M Tähtinen, Borna Tadayon Najafabadi, Philippe D Violette, Robin W M Vernooij, Yuting Wang, Yingqi Xiao, Liang Yao, Daniel Yoo

Affiliations

¹ Department of Surgery, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
² Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
³ Department of Surgery, Päijät-Häme Central Hospital, Lahti, Finland.
⁴ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
⁵ Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
⁶ Chronic Diseases Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
⁷ Department of Medicine, McMaster University, Hamilton, ON, Canada.
⁸ Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
⁹ Outcomes Research Consortium, Cleveland, OH.
¹⁰ Division of Urology, Department of Surgery, Faculty of Medicine, McMaster University, Hamilton, ON, Canada.
¹¹ The Research Institute of St. Joe's Hamilton, Hamilton, ON, Canada.
¹² Department of Urology, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
¹³ Department of Medicine, Western University, London, ON, Canada.
¹⁴ Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.

PMID: 40354313
PMCID: PMC12329283
DOI: 10.1182/bloodadvances.2024015515

The CLUE postsurgery VTE risk instrument for abdominal and pelvic surgery: validation of patient risk factor component

Kari A O Tikkinen et al. Blood Adv. 2025.

. 2025 Aug 12;9(15):3837-3844.

doi: 10.1182/bloodadvances.2024015515.

Authors

Collaborators

CLUE Post-Surgery VTE Risk Instrument Group:
Riikka L Aaltonen, Arnav Agarwal, Chika Agbassi, Kaisa Ahopelto, Bassel Ali, Karoliina M Aro, Ines Beilmann-Lehtonen, Marco H Blanker, Kostiantyn Bolsunovskyi, Rufus Cartwright, Jovita L Cárdenas, Samantha Craigie, Rachel J Couban, Jaana Elberkennou, Leyla Eryuzlu, Päivi J Galambosi, Herney A Garcia-Perdomo, Fang Zhou Ge, Johanna Geraci, Michael K Gould, Huda A Gomaa, Rachel Gutschon, Alex L E Halme, Jari Haukka, Maha Imam, Nofisat Ismaila, Matthew L Izett-Kay, Ilkka E J Kalliala, Paul J Karanicolas, Denise Kam, Nadina Khamani, Tuomas P Kilpeläinen, Antti J Kivelä, Kirsi M Joronen, Hanna Lampela, Yung Lee, Anna L Luomaranta, Anne K Mattila, Giacomo Novara, Richard Naspro, Taina P Nykänen, Sanna M Oksjoki, Sanjay Pandanaboyana, Negar Pourjamal, Chathura B B Ratnayake, Aleksi R Raudasoja, Ville J Sallinen, Per Morten Sandset, Reed A Siemieniuk, Tino Singh, Riikka M Tähtinen, Borna Tadayon Najafabadi, Philippe D Violette, Robin W M Vernooij, Yuting Wang, Yingqi Xiao, Liang Yao, Daniel Yoo

Affiliations

¹ Department of Surgery, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
² Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
³ Department of Surgery, Päijät-Häme Central Hospital, Lahti, Finland.
⁴ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
⁵ Division of Hematology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
⁶ Chronic Diseases Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
⁷ Department of Medicine, McMaster University, Hamilton, ON, Canada.
⁸ Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
⁹ Outcomes Research Consortium, Cleveland, OH.
¹⁰ Division of Urology, Department of Surgery, Faculty of Medicine, McMaster University, Hamilton, ON, Canada.
¹¹ The Research Institute of St. Joe's Hamilton, Hamilton, ON, Canada.
¹² Department of Urology, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
¹³ Department of Medicine, Western University, London, ON, Canada.
¹⁴ Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.

PMID: 40354313
PMCID: PMC12329283
DOI: 10.1182/bloodadvances.2024015515

Abstract

Venous thromboembolism (VTE) remains a major postoperative risk. Systematic reviews have established procedure-specific VTE risk estimates, which form 1 component of the CLUE postsurgery VTE risk instrument. The instrument also incorporates patient-level factors, including age (≥75 years), body mass index (≥35 kg/m2), and prior VTE, to stratify overall risk. However, the patient risk factor component has not been formally validated. Therefore, we conducted the validation using data from the VISION study, a prospective, international cohort of 11 636 patients undergoing major general abdominal, urologic, or gynecologic surgery. Thirty-day postoperative VTE incidence was analyzed using modified Poisson regression. The instrument classified patients into low- (72%), medium- (25%), and high-risk (4%) categories. VTE occurred in 97 patients (0.8%). Compared to the low-risk group, the relative risk of VTE was 1.56 (95% confidence interval [CI], 1.01-2.43) for medium-risk patients and 3.60 (95% CI, 1.90-6.83) for high-risk patients. Among patients who did not receive antithrombotic medication, relative risks increased to 1.91 for medium-risk patients and 5.41 for high-risk patients. The CLUE postsurgery VTE risk instrument, using 3 widely available patient-level factors, accurately classifies patients into substantially different categories of relative VTE risk. This validated patient component complements procedure-specific absolute risk estimates derived from prior systematic reviews. To support evidence-based thromboprophylaxis decisions, the instrument is now available through an interactive online platform (www.cluevte.org).

© 2025 American Society of Hematology. Published by Elsevier Inc. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved.

PubMed Disclaimer

Conflict of interest statement

Conflict-of-interest disclosure: D.S. reported honoraria paid to her institution from AstraZeneca, Bristol Myers Squibb-Pfizer, Roche, and Servier, unrelated to the current work. P.J.D. reported receiving grants from Abbott Diagnostics, AOP Pharma, Renibus, Roche Diagnostics, and Siemens; monitoring services from CloudDX and Philips Healthcare; serving as a consultant for Abbott Diagnostics, AstraZeneca, Bayer, Roche Canada, and Trimedic; and serving as an advisory board member for Bayer and Quidel outside the submitted work. F.K.B. reported receiving investigator-initiated grants from Roche Diagnostics and Siemens, unrelated to the current work. K.A.O.T. was chair of the European Association of Urology Guideline on Thromboprophylaxis in Urological Surgery; a panel member of the American Society of Hematology Thromboprophylaxis guideline on prevention of venous thromboembolism (VTE) in surgical hospitalized patients; and urology subgroup chair of the European Society of Anesthesiology and Intensive Care Task Force for the European Guidelines on VTE. G.H.G. was a panel member of the European Association of Urology Guideline on Thromboprophylaxis in Urological Surgery. The remaining authors declare no competing financial interests.

A complete list of collaborator authors of CLUE Postsurgery VTE Risk Instrument Group appears in “Appendix.”

Figures

**Figure 2.**
**Cumulative incidence of postsurgery VTE stratified by the CLUE postsurgery VTE risk instrument.** Low risk was BMI <35 kg/m², age <75 years, without history of VTE. Medium risk was BMI ≥35 kg/m² or age ≥75 years, without history of VTE. High risk was history of VTE or both of BMI ≥35 kg/m² and age ≥75 years.

See this image and copyright information in PMC

References

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The CLUE postsurgery VTE risk instrument for abdominal and pelvic surgery: validation of patient risk factor component

Collaborators

Affiliations

The CLUE postsurgery VTE risk instrument for abdominal and pelvic surgery: validation of patient risk factor component

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical