Arnold D M, Kahn S R, Shrier I
Department of Medicine, Sir Mortimer B. Davis Jewish General Hospital, Montreal, Canada.
Chest. 2001 Dec;120(6):1964-71. doi: 10.1378/chest.120.6.1964.
To identify and characterize cases of potentially preventable venous thromboembolism (VTE): cases for which thromboprophylaxis was indicated, according to the American College of Chest Physicians (ACCP) consensus guidelines for VTE prevention, yet was administered inadequately.
A historical cohort study to examine all cases of deep vein thrombosis and pulmonary embolism from 1996 to 1997 at a large teaching hospital. Of these, we determined the proportion that was potentially preventable. We examined the reasons for inadequacy of prophylaxis and the setting in which preventable VTE occurred.
Of 253 objectively diagnosed cases of VTE in 245 patients, 44 cases (17.4%) were considered potentially preventable. This represented two thirds of all VTE cases for which thromboprophylaxis had been indicated (n = 65). Of preventable cases, the most frequent reason for inadequacy of prophylaxis was omission of prophylaxis (47.7%), followed by inadequate duration of prophylaxis (22.7%), and by incorrect type of prophylaxis (20.5%). Surgical and medical indications for thromboprophylaxis that were common among preventable cases included nonorthopedic surgery, admission to hospital for pneumonia, and stroke with lower limb paralysis. Underlying risk factors for VTE that were common among preventable cases included recent immobility, active cancer, and obesity.
One of six cases of all VTE and two of three cases of VTE for which thromboprophylaxis had been indicated could potentially have been prevented had physicians followed the recommended ACCP guidelines. Inadequacy of prophylaxis was most often caused by omission of prophylaxis. Missed opportunities for prevention occurred most commonly in the settings of nonorthopedic surgery, pneumonia, and stroke.
识别并描述潜在可预防的静脉血栓栓塞症（VTE）病例：根据美国胸科医师学会（ACCP）预防VTE的共识指南，这些病例需要进行血栓预防，但预防措施实施不当。
一项回顾性队列研究，旨在调查一家大型教学医院1996年至1997年期间所有深静脉血栓形成和肺栓塞病例。在这些病例中，我们确定了潜在可预防病例的比例。我们研究了预防措施不足的原因以及可预防VTE发生的背景。
在245例患者中确诊的253例VTE病例中，44例（17.4%）被认为是潜在可预防的。这占所有已表明需要进行血栓预防的VTE病例的三分之二（n = 65）。在可预防的病例中，预防措施不足最常见的原因是预防措施的遗漏（47.7%），其次是预防持续时间不足（22.7%），以及预防类型错误（20.5%）。在可预防病例中常见的血栓预防手术和医学指征包括非骨科手术、因肺炎住院以及伴有下肢瘫痪的中风。在可预防病例中常见的VTE潜在危险因素包括近期活动减少、活动性癌症和肥胖。
如果医生遵循推荐的ACCP指南，所有VTE病例中的六分之一以及三分之二已表明需要进行血栓预防的VTE病例可能会被预防。预防措施不足最常由预防措施的遗漏引起。预防机会的错失最常见于非骨科手术、肺炎和中风的情况下。
