SHM Converge Scientific Abstract ePoster Gallery-Catching Blood Clots in a Heavier World: A Call to Update Vte Risk Assessment Models

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This case report argues that current venous thromboembolism (VTE) risk models underweight the role of obesity. Although studies show obesity substantially increases VTE risk, commonly used tools such as Wells, Geneva, Padua, and Caprini either omit body mass index (BMI) or do not distinguish between obesity classes well enough to reflect true risk.<br /><br />The report describes a 28-year-old man with extreme obesity (447 lb, BMI 59.92) hospitalized for spinal surgery. He initially appeared low risk by standard scoring systems: Padua score 1, low cardiac risk by GUPTA, and no major cardiac or vascular history. Despite this, while awaiting surgery he developed atrial fibrillation and then suddenly became unresponsive. Imaging revealed a massive saddle pulmonary embolism and right-leg deep vein thromboses. He required thrombolysis with tPA and later anticoagulation with apixaban.<br /><br />The authors explain that obesity creates a prothrombotic state through chronic inflammation, impaired fibrinolysis, increased platelet activation, endothelial dysfunction, and stasis. They note that even though obesity is an independent VTE risk factor, it is often underrepresented in hospital risk-stratification tools. Existing models also show limited predictive accuracy in large hospital populations.<br /><br />The conclusion is that body habitus should be more explicitly integrated into VTE screening and prophylaxis decisions. Better models may improve identification of high-risk patients, reduce preventable clots, and guide more effective prevention strategies, especially as obesity becomes increasingly prevalent.

Asset Subtitle

Nicole M. Leonick

Meta Tag

Author List Andrew G. Ajemian, Divya Shivakumar, Nicole M. Leonick

Category Clinical Vignettes

Concept Obesity

Concept Body Mass Index

Concept Venous Thromboembolism

Concept Deep Vein Thrombosis

Concept Pulmonary Embolism

Distinguished Non-Finalist

Presenter Organization Cooper Medical School of Rowan University

Presenting Author Nicole M. Leonick

Track Adult

Keywords

venous thromboembolism

obesity

body mass index

pulmonary embolism

deep vein thrombosis

risk stratification

Caprini score

Padua score

thrombolysis

prophylaxis

Obesity

Body Mass Index

Venous Thromboembolism

Deep Vein Thrombosis

Pulmonary Embolism