Hôpitaux Universitaires de Genève, Geneva, Switzerland.
Swiss Med Wkly. 2009 Oct 31;139(43-44):630-5. doi: 10.4414/smw.2009.12746.
The aim of the present analysis from the epidemiologic international day for the evaluation of patients at risk for venous thromboembolism (VTE) in the acute hospital care setting (ENDORSE) study was to evaluate the prevalence of VTE risk in acute care hospitals and the proportion of at-risk medical and surgical patients who receive recommended prophylaxis in Switzerland.
All patients (age >or=40 years) admitted to a medical ward or those (age >or=18 years) admitted to a surgical ward in ten randomly selected Swiss hospitals were assessed for risk of VTE. The 2004 American College of Chest Physicians (ACCP) evidence-based consensus guidelines were used to assess VTE risk and to determine whether patients were receiving recommended thromboprophylaxis.
2000 patients were eligible; of these 1153 (58%) were in surgical wards, and 847 (42%) in medical wards. According to the ACCP criteria, the proportion of surgical patients at VTE risk was similar in Switzerland (68%, between hospital range 48-86%) in comparison to the global ENDORSE study (64%) (p = 0.296). The rate of at-risk medical patients was lower in Switzerland (21%, range 3-44%) than in the global study (42%) (p <0.001). The proportion of at-risk surgical patients with ACCP-recommended VTE prophylaxis was higher in Switzerland (81%, between-hospital range 76-93%) than in the global study (59%) (p <0.001). Among medical patients at risk, the use of recommended thromboprophylaxis was higher in Switzerland (61%, between-hospital range 0-84%) than in the global ENDORSE (40%) (p <0.001). However 56% of the patients with cancer, 41% with major trauma, and 29% undergoing vascular surgery did not receive any recommended prophylaxis. Among surgical patients at risk, the use of ACCP-recommended prophylaxis was lower in academic (77%) vs. non-academic (86%) institutions (p = 0.0025).
In Switzerland, although the rate of recommended thromboprophylaxis is higher than in many countries, it is still improvable in medical patients at risk according to the ACCP guidelines. Consequently, hospital wide strategies for systematic risk factor assessment and implementation of practical tools to ensure appropriate use of prophylaxis in patients at VTE risk are required.
本分析来自于国际评估静脉血栓栓塞症（VTE）风险患者日（ENDORSE）研究，旨在评估瑞士急性护理医院的 VTE 风险患病率以及接受推荐预防治疗的高危内科和外科患者的比例。
在 10 家随机选择的瑞士医院中，所有（年龄≥40 岁）入住内科病房或（年龄≥18 岁）入住外科病房的患者均进行 VTE 风险评估。采用 2004 年美国胸科医师学会（ACCP）循证共识指南评估 VTE 风险，并确定患者是否接受推荐的血栓预防治疗。
共纳入 2000 例患者；其中 1153 例（58%）患者入住外科病房，847 例（42%）患者入住内科病房。根据 ACCP 标准，瑞士外科患者的 VTE 风险比例与全球 ENDORSE 研究（64%）相似（68%，医院范围 48-86%）（p=0.296）。瑞士内科高危患者比例（21%，范围 3-44%）低于全球研究（42%）（p<0.001）。瑞士接受 ACCP 推荐 VTE 预防治疗的高危外科患者比例（81%，医院范围 76-93%）高于全球研究（59%）（p<0.001）。在高危内科患者中，瑞士推荐使用血栓预防治疗的比例（61%，医院范围 0-84%）高于全球 ENDORSE 研究（40%）（p<0.001）。然而，56%的癌症患者、41%的严重创伤患者和 29%的血管手术患者未接受任何推荐的预防治疗。高危外科患者中，学术机构（77%）接受 ACCP 推荐预防治疗的比例低于非学术机构（86%）（p=0.0025）。
尽管瑞士推荐使用血栓预防治疗的比例高于许多国家，但根据 ACCP 指南，高危内科患者仍有改进的空间。因此，需要制定全院范围的风险因素评估策略，并实施实用工具，以确保高危 VTE 患者适当使用预防治疗。
