Gussoni Gualberto, Campanini Mauro, Silingardi Mauro, Scannapieco Gianluigi, Mazzone Antonino, Magni Giovanna, Valerio Antonella, Iori Ido, Ageno Walter
FADOI - Centro Studi, Via G.B. Bazzoni 8, Milano, Italy.
Thromb Haemost. 2009 May;101(5):893-901.
Hospitalised medical patients are at increased risk of venous thromboembolism (VTE), but the incidence of hospitalisation-related VTE in unselected medical inpatients has not been extensively studied, and uncertainties remain about the optimal use of thromboprophylaxis in this setting. Aims of our prospective, observational study were to assess the prevalence of VTE and the incidence of symptomatic, hospitalisation-related events in a cohort of consecutive patients admitted to 27 Internal Medicine Departments, and to evaluate clinical factors associated with the use of thromboprophylaxis. Between March and September 2006, a total of 4,846 patients were included in the study. Symptomatic VTE with onset of symptoms later than 48 hours after admission ("hospital-acquired" events, primary study end-point) occurred in 26 patients (0.55%), while the overall prevalence of VTE (including diagnosis prior to or at admission) was 3.65%. During hospital stay antithrombotic prophylaxis was administered in 41.6% of patients, and in 58.7% of those for whom prophylaxis was recommended according to the 2004 Guidelines of the American College of Chest Physicians. The choice of administering thromboprophylaxis or not appeared qualitatively adherent to indications from randomised clinical trials and international guidelines, and bed rest was the strongest determinant of the use of prophylaxis. Data from our real-world study confirm that VTE is a relevant complication in patients admitted to Internal Medicine Departments, and recommended tromboprophylaxis is still under-used, in particular in some patients groups. Further efforts are needed to better define risk profile and to optimise prophylaxis in the heterogeneous setting of medical inpatients.
住院内科患者发生静脉血栓栓塞症（VTE）的风险增加，但在未经过筛选的内科住院患者中，与住院相关的VTE发病率尚未得到广泛研究，并且在这种情况下预防血栓形成的最佳用药仍存在不确定性。我们这项前瞻性观察性研究的目的是评估在27个内科科室连续收治的一组患者中VTE的患病率以及有症状的、与住院相关事件的发生率，并评估与预防血栓形成用药相关的临床因素。2006年3月至9月期间，共有4846例患者纳入本研究。症状性VTE（症状在入院后48小时后出现，即“医院获得性”事件，为主要研究终点）发生在26例患者中（0.55%），而VTE的总体患病率（包括入院前或入院时诊断出的）为3.65%。住院期间，41.6%的患者接受了抗血栓预防治疗，在根据美国胸科医师学会2004年指南建议应接受预防治疗的患者中，这一比例为58.7%。是否进行血栓预防的选择在质量上似乎符合随机临床试验和国际指南的指征，卧床休息是预防用药的最强决定因素。我们这项真实世界研究的数据证实，VTE是内科住院患者的一种相关并发症，推荐的血栓预防措施仍未得到充分应用，尤其是在一些患者群体中。需要进一步努力，以更好地确定风险特征，并在内科住院患者这种异质性环境中优化预防措施。
