Hôpital Lariboisière, University Paris 7, Paris, France.
Thromb Haemost. 2010 Apr;103(4):736-48. doi: 10.1160/TH09-09-0667. Epub 2010 Feb 2.
Limited data are available regarding the risk for venous thromboembolism (VTE) and VTE prophylaxis use in hospitalised medically ill patients. We analysed data from the global ENDORSE survey to evaluate VTE risk and prophylaxis use in this population according to diagnosis, baseline characteristics, and country. Data on patient characteristics, VTE risk, and prophylaxis use were abstracted from hospital charts. VTE risk and prophylaxis use were evaluated according to the 2004 American College of Chest Physicians (ACCP) guidelines. Multivariable analysis was performed to identify factors associated with use of ACCP-recommended prophylaxis. Data were evaluated for 37,356 hospitalised medical patients across 32 countries. VTE risk varied according to medical diagnosis, from 31.2% of patients with gastrointestinal/hepatobiliary diseases to 100% of patients with acute heart failure, active non-infectious respiratory disease, or pulmonary infection (global rate, 41.5%). Among those at risk for VTE, ACCP-recommended prophylaxis was used in 24.4% haemorrhagic stroke patients and 40-45% of cardiopulmonary disease patients (global rate, 39.5%). Large differences in prophylaxis use were observed among countries. Markers of disease severity, including central venous catheters, mechanical ventilation, and admission to intensive care units, were strongly associated with use of ACCP-recommended prophylaxis. In conclusion, VTE risk varies according to medical diagnosis. Less than 40% of at-risk hospitalised medical patients receive ACCP-recommended prophylaxis. Prophylaxis use appears to be associated with disease severity rather than medical diagnosis. These data support the necessity to improve implementation of available guidelines for evaluating VTE risk and providing prophylaxis to hospitalised medical patients.
关于住院内科患者静脉血栓栓塞症 (VTE) 风险和 VTE 预防用药的数据有限。我们分析了全球 ENDORSE 调查的数据，以根据诊断、基线特征和国家评估该人群的 VTE 风险和预防用药情况。从医院病历中提取患者特征、VTE 风险和预防用药的数据。根据 2004 年美国胸科医师学会 (ACCP) 指南评估 VTE 风险和预防用药。进行多变量分析以确定与 ACCP 推荐预防用药相关的因素。对来自 32 个国家的 37356 例住院内科患者的数据进行了评估。VTE 风险根据内科诊断而有所不同，从胃肠道/肝胆疾病患者的 31.2%到急性心力衰竭、活动性非传染性呼吸道疾病或肺部感染患者的 100%（全球发生率为 41.5%）。在有 VTE 风险的患者中，ACCP 推荐预防用药的使用率为出血性脑卒中患者的 24.4%和心肺疾病患者的 40-45%（全球发生率为 39.5%）。各国之间的预防用药差异很大。疾病严重程度的标志物，包括中心静脉导管、机械通气和入住重症监护病房，与 ACCP 推荐的预防用药有很强的相关性。总之，VTE 风险根据内科诊断而有所不同。不到 40%的有风险的住院内科患者接受 ACCP 推荐的预防用药。预防用药的使用似乎与疾病严重程度有关，而与内科诊断无关。这些数据支持有必要改进评估住院内科患者 VTE 风险和提供预防用药的现有指南的实施。
