Shifting the context from the emergency department to the department of medicine, we compared different scores to diagnose deep vein thrombosis (DVT) in patients with several comorbidities, hospitalized in a department of internal medicine. We prospectively recruited 178 consecutive hospitalized patients in whom clinical suspicion of DVT was assessed by Wells modified score for DVT, Hamilton, Kahn, and St Andrè Hospital scores. Deep vein thrombosis was confirmed in 85 (48%) patients by both echocolor Doppler and angiocomputed tomography scan. The use of risk scores based on symptoms and clinical signs was weakly useful (area under the curve [AUC]: 0.69, positive predictive value: 59%, and negative predictive value: 74%). Patients with DVT had significantly (P < .0001) lower serum albumin and protein S levels compared to those without DVT. Moreover, serum protein S (AUC: 0.82) and albumin in percentage (AUC: 0.80) showed a better accuracy than clinical scores (P < .001) in assessing the diagnosis of DVT. Therefore, serum albumin and protein S improved the accuracy of clinical scores for the diagnosis of incident DVT in patients hospitalized in a department of medicine.
GoldhaberSZ. Venous thromboembolism: epidemiology and magnitude of the problem. Best Pract Res Clin Haematol. 2012;25(3):235–242.
2.
GoldsmithHLTurittoVT. Rheological aspects of thrombosis and haemostasis: basic principles and applications. ICTH-Report–Subcommittee on Rheology of the International Committee on Thrombosis and Haemostasis. Thromb Haemost. 1986;55(3):415–35.
3.
DahlbackB. Progress in the understanding of the protein C anticoagulant pathway. Int J Hematol. 2004;79(2):109–116.
4.
GardinerJEMcGannMABerridgeCWFulcherCAZimmermanTSGrifinJH. Protein S as a cofactor for activated protein C in plasma and in the inactivation of purified factor VIII. Circulation. 1984;70(2):205.
5.
MontagnanaMFavaloroE JFranchiniMGuidiG CLippiG. The role of ethnicity, age and gender in venous thromboembolism. J Thromb Thrombolysis. 2010;29(4):489–496.
6.
KreidyRSalamehPWakedM. Lower extremity venous thrombosis in patients younger than 50 years of age. Vasc Health Risk Manag. 2012;8:161–117.
7.
AgnelliGVersoM. Management of venous thromboembolism in patients with cancer. J Thromb Haemost. 2011;9(suppl 1):316–324.
8.
GoldhaberSZ. Risk factors for venous thromboembolism. J Am Coll Cardiol. 2010;56(1):1–7.
9.
RizkallahJManSFSinDD. Prevalence of pulmonary embolism in acute exacerbations of COPD: a systematic review and metaanalysis. Chest. 2009;135(3):786–793.
10.
FolsomARLutseyPLAstorBCCushmanM. C-reactive protein and venous thromboembolism. A prospective investigation in the ARIC cohort. Thromb Haemost. 2009;102(4):615–619.
11.
Blanco-MolinaATrujillo-SantosJTiradoRCañasIRieraAValdésM. Venous thromboembolism in women using hormonal contraceptives. Findings from the RIETE Registry. Thromb Haemost. 2009;101(3):478–482.
12.
Anthony LizarragaWDaliaSReinertSESchiffmanFJ. Venous thrombosis in patients with chronic liver disease. Blood Coagul Fibrinolysis. 2010;21(5):431–435.
13.
GulleyDTealESuvannasankhaAChalasaniNLiangpunsakulS. Deep vein thrombosis and pulmonary embolism in cirrhosis patients. Dig Dis Sci. 2008;53(11):3012–3017.
14.
KucherN. Clinical practice. Deep-vein thrombosis of the upper extremities. N Engl J Med. 2011;364(9):861–869.
15.
WellsPSAndersonDRBormanisJ. Value of assessment of pretest probability of deep-vein thrombosis in clinical management. Lancet. 1997;350(9094):1795–1798.
16.
SubramaniamRMChouTHeathRAllenR. Importance of pretest probability score and d-dimer assay before sonography for lower limb deep venous thrombosis. Am J Roentgenol. 2006;186(1):206–212.
17.
KahnSRJosephLAbenhaimLLeclercJR. Clinical prediction of deep vein thrombosis in patient with leg symptoms. Thromb Haemost. 1999;81(3):353–357.
18.
ConstansJNelzyMLSalmiLR. Clinical prediction of lower limb deep vein thrombosis in symptomatic hospitalized patients. Thromb Haemost. 2001;86(4):985–990.
19.
ConstansJBoutinetCSalmiLR. Comparison of four clinical prediction scores for the diagnosis of lower limb deep venous thrombosis in outpatients. Am J Med. 2003;115(6):436–440.
20.
BienvenuJGrazianiMSArpinF. Multicenter evaluation of the Paragon CZE 2000 capillary zone electrophoresis system for serum protein electrophoresis and monoclonal component typing. Clin Chem. 1998;44(3):599–605.
21.
KemkesMB. Acquired protein S deficiency. Clin Invest. 1992;70(6):529–534.
22.
SubramaniamRMSnyderBHeathRTawseFSleighJ. Diagnosis of lower limb deep venous thrombosis in emergency department patients: performance of Hamilton and modified wells scores. Ann Emerg Med. 2006;48(6):678–685.
23.
MikhailidisDPMikhailidisAMDandonaP. Effect of human plasma proteins on stabilisation of platelet anti-aggregatory activity of prostacyclin. Ann Clin Biochem. 1982;19(pt 4):241–214.
24.
SchieppatiADodesiniPBenigniA. The metabolism of arachidonic acid by platelets in nephrotic syndrome. Kidney Int. 1984;25(4):671–616.
25.
MikhailidisDPBarradasMAMarisAJeremyJYDandonaP. Fibrinogen mediated activation of platelet aggregation and thromboxane A2 release: pathological implications in vasculardisease. J Clin Pathol. 1985;38(10):1166–1171.
26.
MikhailidisDPGanotakisES. Plasma albumin and platelet function: relevance to atherogenesis and thrombosis. Platelets. 1996;7(3):125–137.
27.
ZoccaliCBenedettoFAFocàA. C-reactive protein and atherosclerosis in dialysis patients. Nephrol Dial Transplant. 1998;13(10):2710–2711.
28.
MalatinoLSBenedettoFAMallamaciF. Smoking, blood pressure and serum albumin are major determinants of carotid atherosclerosis in dialysis patients. CREED Investigators. Cardiovascular Risk Extended Evaluation in Dialysis patients. J Nephrol. 1999;12(4):256–260.
29.
KrijgsmanBPapadakisJAGanotakisESMikhailidisDPHamiltonG. The effect of peripheral vascular disease on the serum levels of natural anti-oxidants: bilirubin and albumin. Int Angiol. 2002;21(1):44–52.
30.
GanotakisESVrentzosGEGaziIF. Fibrinogen, lipoprotein (a), albumin and bilirubin (F-L-A-B) levels and cardiovascular risk calculated using the Framingham equation. In Vivo. 2007;21(4):685–694.
31.
WattanakitKCushmanM. Chronic kidney disease and venous thromboembolism: epidemiology and mechanism. Curr Opin Pulm Med. 2009;15(5):408–412.
32.
TripodiAMannucciPM. The coagulopathy of chronic liver disease. N Engl J Med. 2011;365(2):147–156.
33.
BarbanoBGiganteAAmorosoACianciR. Thrombosis in nephrotic syndrome. Semin Thromb Haemost. 2013;39(5):469–476.
34.
KohoutovaDPeckaMCihakM. Prevalence of hypercoagulable disorders in inflammatory bowel disease. Scand J Gastroenterol. 2014;49(3):287–294.
35.
GiganteABarbanoBSardoL. Hypercoagulability and nephrotic syndrome. Curr Vasc Pharmacol. 2014;12(3):512–517.
36.
GoodwinLVGoggsRChanDLAllenspachK. Hypercoagulability in dogs with protein loosing enteropathy. J Vet Intern Med. 2011;25(2):273–217.
37.
CeredaEPedrolliCZagamiA. Nutritional risk, functional status and mortality in newly institutionalized elderly. Br J Nutr. 2013;110(10):1903–1919.
