Ageno Walter, Squizzato Alessandro, Ambrosini Fabio, Dentali Francesco, Marchesi Chiara, Mera Valentina, Steidl Luigi, Venco Achille
Department of Internal Medicine, University of Insubria, Italy.
Haematologica. 2002 Jul;87(7):746-50; discussion 250.
The risk of venous thromboembolism in medical patients is comparable to the risk in general surgical patients. Thromboprophylaxis is recommended for specific medical patients, but its use in clinical practice is unknown.
We conducted a retrospective review of the charts of consecutive patients discharged from 2 departments of Internal Medicine, one in the teaching hospital of Varese and one in the non-teaching hospital of Angera, Italy, from October to December 2000. We selected the charts of patients with clinical conditions at increased risk of venous thromboembolism requiring thromboprophylaxis according to consensus statements. The use of antithrombotic drugs and contraindications to prophylaxis were documented.
We screened a total of 516 charts, 265 in Varese and 251 in Angera and we identified 165 patients (103 and 62, respectively) at risk of venous thromboembolism because of malignancy (53), heart failure (34), stroke (33), acute infections (23), acute respiratory failure (18), acute rheumatic disorders (3), and inflammatory bowel disease (1). Forty-two patients had contraindications to antithrombotic drugs and 11 were already on long-term oral anticoagulant treatment. Among the 112 remaining patients, prophylaxis was prescribed to 52 patients (46.4%), 35 of 60 in Varese (58.3%) and 17 of 52 in Angera (32.7%, p=0.0067). Patients with stroke and heart failure were significantly more likely to receive thromboprophylaxis than other groups of patients.
Prophylaxis of venous thromboembolism is underused in medical patients and the proportion of patients receiving antithrombotic drugs varies with the medical condition which precipitated hospital admission. The low rate of usage of prophylaxis suggests that preventable cases of thromboembolism are occurring and that better education of physicians is required to increase the usage of thromboprophylaxis.
内科患者发生静脉血栓栓塞的风险与普通外科患者相当。推荐对特定内科患者进行血栓预防，但在临床实践中的使用情况尚不清楚。
我们对2000年10月至12月间从意大利瓦雷泽教学医院和安赫拉非教学医院的两个内科科室连续出院患者的病历进行了回顾性研究。根据共识声明，我们选择了有静脉血栓栓塞风险增加的临床状况且需要进行血栓预防的患者的病历。记录了抗血栓药物的使用情况和预防的禁忌症。
我们共筛查了516份病历，其中瓦雷泽265份，安赫拉251份，我们确定了165例有静脉血栓栓塞风险的患者（分别为103例和62例），原因包括恶性肿瘤（53例）、心力衰竭（34例）、中风（33例）、急性感染（23例）、急性呼吸衰竭（18例）、急性风湿性疾病（3例）和炎症性肠病（1例）。42例患者有抗血栓药物的禁忌症，11例已经在接受长期口服抗凝治疗。在其余112例患者中，52例（46.4%）接受了预防措施，瓦雷泽60例中的35例（58.3%），安赫拉52例中的17例（32.7%，p = 0.0067）。中风和心力衰竭患者比其他患者组更有可能接受血栓预防。
内科患者对静脉血栓栓塞的预防措施使用不足，接受抗血栓药物治疗的患者比例因导致住院的内科疾病而异。预防措施的低使用率表明，可预防的血栓栓塞病例正在发生，需要对医生进行更好的教育以提高血栓预防措施的使用率。
Zotero 插件