The (T) thrombosis (I) in patients with (L) lower (L) limb (I) injuries (R) requiring (I) immobilisation (TILLIRI) study

IF 5.5 2区医学 Q1 HEMATOLOGY

Journal of Thrombosis and Haemostasis Pub Date : 2025-03-01 DOI:10.1016/j.jtha.2024.11.010

Thomas P.O. Halloran , Bibi Ayesha Bassa , Banne Nemeth , Suzanne Cannegieter , Tomas Breslin , Abel Wakai , Julie O'Driscoll , Sean O'Rourke , Niamh O'Connell , Fionnuala ní Áinle , Michael Watts , Denis O. Keeffe , TILLIRI study investigators

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引用次数: 0

Abstract

Background

Patients requiring lower limb immobilization after injury have an increased venous thromboembolism (VTE) risk. The extent of this risk in published studies varies. The Thrombosis Risk Prediction for Patients with Cast Immobilization (TRiP[cast]) model quantifies VTE risk using clinical parameters. Delineating low-risk from high-risk patients remains challenging.

Objectives

Determine the 90-day incidence of symptomatic VTE following temporary lower limb immobilization after injury in an unselected cohort. Prospectively collect data on risk factors, including those incorporated in the TRiP(cast) model, to calculate TRiP(cast) scores.

Methods

TILLIRI is a multicenter, pragmatic, observational cohort study including 10 sites within the Irish Network for VTE Research. Patients aged ≥18 years with an immobilized injured lower limb were included. Twenty-one clinical variables were collected at presentation. Thromboprophylaxis was prescribed according to clinical gestalt. Patients were followed up at 90 days to determine if VTE occurred.

Results

Between November 2018 and February 2023, 1242 patients were recruited. Follow-up was complete for 1199 patients (96.5%). Forty-three patients (3.5%) were lost to follow-up. Forty-four (3.6%) patients and 125 (10%) patients were prescribed anticoagulation and aspirin, respectively. Twenty-one patients receiving regular anticoagulation were removed from the final analysis. VTE incidence at 90-day follow-up was 6/1179 (0.51%; 95% CI, 0.1%-0.92%). TRiP(cast) scores were calculated for 1176/1221 patients. A total of 846 patients (71.9%) had a TRiP(cast) score < 7, received no prophylaxis, and had no VTE.

Conclusion

TILLIRI indicates a low VTE incidence in an unselected cohort following lower limb immobilization with low rates of prophylaxis use. The proportion of patients with low TRiP(cast) scores and no symptomatic VTE suggests that thromboprophylaxis may be avoided in patients with TRiP(cast) scores < 7 with a low 90-day VTE risk.

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(L)下肢(L)损伤(R)需要(I)固定（TILLIRI）的患者(T)血栓形成(I)研究。

背景：受伤后需要下肢固定的患者有增加的静脉血栓栓塞（VTE）风险。在已发表的研究中，这种风险的程度各不相同。TRiP（cast）模型使用临床参数量化静脉血栓栓塞风险。区分低危患者和高危患者仍然具有挑战性。目的：在未选择的队列中确定受伤后暂时下肢固定后90天症状性静脉血栓栓塞的发生率。前瞻性地收集风险因素的数据，包括那些纳入TRiP（cast）模型的数据，计算TRiP（cast）评分。方法：TILLIRI是一项多中心、实用的观察队列研究，包括爱尔兰VTE研究网络中的10个站点。患者年龄≥18岁，下肢受伤不能活动。在就诊时收集了21个临床变量。根据临床格式塔进行血栓预防。患者随访90天，以确定是否发生静脉血栓栓塞。结果：在2018年11月至2023年2月期间，招募了1242名患者。1199例（96.5%）患者完成随访。失访43例（3.5%），分别给予抗凝剂44例（3.6%）和阿司匹林125例（10%）。21例接受常规抗凝治疗的患者从最终分析中剔除。90天随访时静脉血栓栓塞发生率为6/1179(0.51%；CI 0.1% - -0.92%)。计算1176/1221例患者的TRiP（cast）评分。846例（71.9%）患者的TRiP（cast）评分< 7，未接受预防治疗，未发生静脉血栓栓塞。结论：TILLIRI表明，在未选择的队列中，下肢固定后静脉血栓栓塞发生率低，预防使用率低。低TRiP（cast）评分和无症状性VTE的患者比例表明，TRiP（cast）评分< 7的患者可以避免血栓预防，其90天VTE风险较低。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Thrombosis and Haemostasis 医学-外周血管病

CiteScore

24.30

自引率

3.80%

发文量

321

审稿时长

1 months

期刊介绍： The Journal of Thrombosis and Haemostasis (JTH) serves as the official journal of the International Society on Thrombosis and Haemostasis. It is dedicated to advancing science related to thrombosis, bleeding disorders, and vascular biology through the dissemination and exchange of information and ideas within the global research community. Types of Publications: The journal publishes a variety of content, including: Original research reports State-of-the-art reviews Brief reports Case reports Invited commentaries on publications in the Journal Forum articles Correspondence Announcements Scope of Contributions: Editors invite contributions from both fundamental and clinical domains. These include: Basic manuscripts on blood coagulation and fibrinolysis Studies on proteins and reactions related to thrombosis and haemostasis Research on blood platelets and their interactions with other biological systems, such as the vessel wall, blood cells, and invading organisms Clinical manuscripts covering various topics including venous thrombosis, arterial disease, hemophilia, bleeding disorders, and platelet diseases Clinical manuscripts may encompass etiology, diagnostics, prognosis, prevention, and treatment strategies.