Dentali Francesco, Riva Nicoletta, Gianni Monica, Malato Alessandra, Bozzato Silvia, Bernasconi Matteo, Tuttolomondo Antonino, Romano Adele, Pinto Antonio, Siragusa Sergio, Ageno Walter
Department of Clinical Medicine, Insubria University, Varese, Italy.
Thromb Res. 2008;123(1):67-71. doi: 10.1016/j.thromres.2008.01.009. Epub 2008 Mar 6.
Evidence-based guidelines recommend the use of antithrombotic prophylaxis in medical patients at risk of venous thromboembolism (VTE). Low molecular weight heparins (LMWHs) are usually preferred to unfractionated heparin. However, when prophylactic doses of LMWH are administered, patients with renal failure (RF) are exposed to the risk of excessive accumulation, and thus to an increased risk of bleeding. We aimed to assess the prevalence of RF among medical inpatients at increased risk of VTE and the use and dosage of antithrombotic prophylaxis in these patients.
In a cross sectional study carried out at three different hospitals, information on all medical inpatients was collected. Patients were defined at increased risk of VTE according to the American College of Chest Physicians guidelines. Data on the proportion of patients with renal RF, on the use and dosage of antithrombotic prophylaxis, and on the presence of contraindications to antithrombotic therapy were ascertained.
439 hospital charts were examined; 158 patients (36.0%) were defined at increased risk of VTE and had no contraindications to antithrombotic treatment. Thromboprophylaxis was prescribed to 61.4% of these patients. Eighty (50.7%) of them also had moderate or severe RF. There was no difference in the rate of prescription nor in the doses of antithrombotic prophylaxis between patients with and without RF (p=0.81 and p=0.94, respectively).
RF is frequently present in medical patients at risk of VTE. A considerable proportion of these patients may not receive the optimal type or dose of antithrombotic prophylaxis.
循证指南推荐对有静脉血栓栓塞（VTE）风险的内科患者进行抗血栓预防。低分子量肝素（LMWHs）通常比普通肝素更受青睐。然而，当给予预防剂量的LMWH时，肾衰竭（RF）患者有药物过度蓄积的风险，从而有出血风险增加。我们旨在评估VTE风险增加的内科住院患者中RF的患病率以及这些患者抗血栓预防的使用情况和剂量。
在三家不同医院开展的一项横断面研究中，收集了所有内科住院患者的信息。根据美国胸科医师学会指南，将患者定义为VTE风险增加。确定了肾衰竭患者的比例、抗血栓预防的使用和剂量以及抗血栓治疗禁忌证的存在情况。
检查了439份医院病历；158例患者（36.0%）被定义为VTE风险增加且无抗血栓治疗禁忌证。这些患者中有61.4%接受了血栓预防治疗。其中80例（50.7%）也有中度或重度RF。有RF和无RF的患者在抗血栓预防的处方率和剂量方面均无差异（分别为p = 0.81和p = 0.94）。
RF在有VTE风险的内科患者中很常见。这些患者中有相当一部分可能未接受最佳类型或剂量的抗血栓预防治疗。
