IMPROVEDD Risk Score for Venous Thromboembolism (VTE)
Predicts risk of VTE in hospitalized patients, adding D-dimer to IMPROVE Risk Score.
- No large-scale, multicenter, prospective external validation in a general (non-COVID) medical inpatient cohort has been published.
- Published external validation studies are in hospitalized COVID-19 populations, which may not be generalizable to the broader medical inpatient population for which the score was designed.
- Improved performance over the IMPROVE Risk Score has been inconsistent.
Advice
- Results should complement, not replace, clinical judgment and individual patient assessment.
- Continuously assess the effectiveness and safety of prophylactic measures, adjusting as needed based on patient response and any emerging risk factors.
Management
- Score ≥2:
- The patient is at increased risk for VTE.
- Start appropriate pharmacologic (e.g., low molecular weight heparin) or mechanical (e.g., compression stockings, intermittent pneumatic compression) prophylaxis.
- Score <2:
- The patient is at low risk for VTE.
- Pharmacologic thrombophylaxis is not warranted.
- Early ambulation with or without mechanical prophylaxis may be appropriate.
If pharmacologic prophylaxis is warranted, evaluate for and weigh the risk of bleeding. Consider combining this assessment with the IMPROVE Bleeding Risk Score.
Critical Actions
- This score is meant to risk stratify patients who have a potential risk for VTE, not to diagnose VTE.
- If deemed appropriate, anticoagulation should not be withheld from patients who require it as part of the treatment for their diagnosis.
- Prior to initiating any anticoagulant therapy, a patient’s bleeding risk should be evaluated.