Dorfman M, Chan S B, Maslowski C
Resurrection Emergency Medicine Residency Program, Resurrection Medical Center, Chicago, IL 60631, USA.
J Clin Pharm Ther. 2006 Oct;31(5):455-9. doi: 10.1111/j.1365-2710.2006.00764.x.
Without prophylaxis, hospital-acquired deep vein thrombosis (DVT) is approximately 10-40% among medical or general surgical patients and thromboprophylaxis for high-risk patients is currently recommended. This study analyse the risk factors associated with patients who developed a hospital-acquired venous thromboembolism (VTE) and what prior prophylaxis, if any, were given to these patients.
We identified 1 year of secondary VTE from seven metropolitan hospitals. A random sample was selected and reviewed retrospectively. Data abstracted included age, gender, VTE risk factors, surgeries, VTE prophylaxis, and anticoagulant dosing. Data analysis consisted of descriptive statistics.
A total of 118 patients with mean age 72.1 years (range 23-96) and 55.1% female. There were 60.2% DVT followed by 36.4% pulmonary embolism (PE); 7.6% had both DVT and PE diagnosed. About 73.7% of the study patients had two or more VTE risk factors. Five (4.2%) patients with hospital-acquired VTE had no risk factors. Overall, 88.5% of patients with risk factors received adequate VTE prophylaxis; 20.3% received heparin or enoxaparin, 56.6% received warfarin, and 11.5% received mechanical prophylaxis secondary to drug contraindications. Nine (8.0%) patients with risk factors and no contraindications, did not received any prophylaxis while four patients (3.5%) received inadequate prophylaxis. All-cause mortality was 13.6% (16/118).
Less than 5% of hospital-acquired VTE occurred in patients with no risk factors while 74% occurred in patients with two or more risk factors. In this seven-hospital study, 11.5% of hospital-acquired VTE with prior risk factors did not receive adequate prophylaxis. Educational in-services on the new CHEST guidelines should be provided within the hospitals to increase adherence to prophylaxis guidelines.
在没有预防措施的情况下，内科或普通外科患者发生医院获得性深静脉血栓形成（DVT）的几率约为10%-40%，目前建议对高危患者进行血栓预防。本研究分析了发生医院获得性静脉血栓栓塞症（VTE）的患者的相关危险因素，以及这些患者之前是否接受过预防措施（若有）。
我们从7家大都市医院中确定了1年的继发性VTE病例。选取随机样本并进行回顾性分析。提取的数据包括年龄、性别、VTE危险因素、手术情况、VTE预防措施以及抗凝药物剂量。数据分析采用描述性统计方法。
共有118例患者，平均年龄72.1岁（范围23-96岁），女性占55.1%。DVT占60.2%，其次是肺栓塞（PE）占36.4%；7.6%的患者同时诊断为DVT和PE。约73.7%的研究患者有两个或更多VTE危险因素。5例（4.2%）医院获得性VTE患者没有危险因素。总体而言，88.5%有危险因素的患者接受了充分的VTE预防；20.3%接受肝素或依诺肝素，56.6%接受华法林，11.5%因药物禁忌接受机械预防。9例（8.0%）有危险因素且无禁忌证的患者未接受任何预防措施，而4例患者（3.5%）接受的预防措施不足。全因死亡率为13.6%（16/118）。
不到5%的医院获得性VTE发生在无危险因素的患者中，而74%发生在有两个或更多危险因素的患者中。在这项七家医院的研究中，11.5%有既往危险因素的医院获得性VTE患者未接受充分的预防措施。应在医院内开展关于新的CHEST指南的在职教育，以提高对预防指南的依从性。
