Yu Hsing-Ting, Dylan Michelle L, Lin Jay, Dubois Robert W
Cerner LifeSciences (CLS), Beverly Hills, CA 90212, USA.
Am J Health Syst Pharm. 2007 Jan 1;64(1):69-76. doi: 10.2146/ajhp060115.
A study was conducted to evaluate compliance with the Sixth American College of Chest Physicians (ACCP) Consensus Conference on Antithrombotic Therapy guidelines for the prevention of venous thromboembolism (VTE) in hospitals.
Using the HealthFacts database, hospitalized patients, age 40 years or more, with medical conditions at risk for VTE (surgical, trauma, and acute spinal injury patients) were identified. Hospital admissions on or after January 1, 2001, and concluded by March 31, 2005, were included if they met any of the following conditions as defined in the ACCP Consensus Conference on Antithrombotic Therapy guidelines: patients at risk of VTE medical conditions, major orthopedic surgery, general surgery, gynecological surgery, urologic surgery, trauma, neurosurgery, and acute spinal cord injury. Hospitalizations were identified using the International Classification of Diseases, 9th Revision, Clinical Modification codes. The primary objective was to examine whether patients received one of the indicated anticoagulants at the proper dosage and during the relevant hospital days as determined in the ACCP guidelines. Rates of compliance were assessed, and the reasons for guideline noncompliance were also determined.
The overall compliance rate with ACCP guidelines was 13.3% (ranging from 2.8% for neurosurgery to 52.4% for orthopedic surgery) in the 123,304 hospital admissions that were reviewed. Only 15.3% of patients with at-risk medical conditions received prophylaxis in accordance with ACCP guidelines. Potential reasons for guideline noncompliance among selected conditions included the omission of prophylaxis, inadequate prophylaxis duration, and the wrong type of anticoagulant.
A retrospective study found low rates of compliance with guidelines for thromboprophylaxis.
开展一项研究以评估医院在预防静脉血栓栓塞症（VTE）方面对美国胸科医师学会（ACCP）第六届抗栓治疗共识会议指南的遵循情况。
利用HealthFacts数据库，确定年龄40岁及以上、患有VTE风险疾病（手术、创伤和急性脊髓损伤患者）的住院患者。纳入2001年1月1日及以后入院且在2005年3月31日前结束的病例，条件为符合ACCP抗栓治疗共识会议指南中定义的以下任何一种情况：患有VTE风险疾病的患者、重大骨科手术、普通外科手术、妇科手术、泌尿外科手术、创伤、神经外科手术和急性脊髓损伤。使用国际疾病分类第九版临床修订本代码识别住院情况。主要目的是检查患者是否按照ACCP指南确定的适当剂量并在相关住院天数内接受了一种指定的抗凝剂治疗。评估了遵循率，并确定了未遵循指南的原因。
在审查的123,304例住院病例中，总体遵循ACCP指南的比例为13.3%（从神经外科的2.8%到骨科手术的52.4%不等）。只有15.3%患有风险疾病的患者按照ACCP指南接受了预防治疗。选定情况下未遵循指南的潜在原因包括预防措施遗漏、预防持续时间不足以及抗凝剂类型错误。
一项回顾性研究发现，血栓预防指南的遵循率较低。
