Wiseman Diane N, Harrison Jeff
School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Building 504, 85 Park Road, Grafton, Auckland, New Zealand.
N Z Med J. 2010 Feb 19;123(1309):37-49.
Thromboprophylaxis is highly effective, safe and cost-effective. However, data from international studies have shown that many at-risk hospitalised patients do not receive appropriate prophylaxis, leaving them at risk of venous thromboembolism (VTE) and its consequences.
To assess whether patients readmitted with a VTE to the North Shore Hospital, Auckland, received appropriate thromboprophylaxis during their index admission.
Discharge coding was used to identify all patients admitted for VTE-related events between 1 July 2005 to 30 June 2007. Further analysis identified those patients hospitalised for any cause in the 3 months prior to the VTE event. Data were collected on patient characteristics, risk factors for VTE and the thromboprophylaxis regimen prescribed. The seventh American College of Chest Physicians (ACCP) guidelines on the prevention of venous thromboembolism were used to assess VTE risk and to determine whether patients received appropriate prophylaxis.
Of the 962 patients admitted with a VTE event, 243 (25%) had been hospitalised within the preceding 3 months. 108 patients were eligible for inclusion in the study; 58 were categorized as medical admissions and 50 as surgical. Using the ACCP-defined criteria, 29 (50%) medical and 38 (76%) surgical patients were identified as being at increased risk of VTE. Only one third of at-risk patients received ACCP-recommended prophylaxis during their index hospital admission. More surgical patients received recommended prophylaxis than medical patients, although this was not statistically significant (37% vs 24%, p=0.3, Fisher's exact test).
A significant number of at-risk patients, who subsequently developed VTE after discharge from hospital, failed to receive appropriate thromboprophylaxis during their index admission. Implementing national and local strategies, to improve the use of thromboprophylaxis in hospitalised patients, may help to reduce the burden of VTE.
血栓预防措施高效、安全且具有成本效益。然而，国际研究数据表明，许多住院高危患者未接受适当的预防措施，从而使其面临静脉血栓栓塞（VTE）及其后果的风险。
评估在奥克兰北岸医院再次因VTE入院的患者在其首次入院期间是否接受了适当的血栓预防措施。
通过出院编码识别2005年7月1日至2007年6月30日期间因VTE相关事件入院的所有患者。进一步分析确定了在VTE事件发生前3个月内因任何原因住院的患者。收集了患者特征、VTE危险因素及所开的血栓预防方案的数据。采用美国胸科医师学会（ACCP）第七届预防静脉血栓栓塞指南评估VTE风险并确定患者是否接受了适当的预防措施。
在962例因VTE事件入院的患者中，243例（25%）在之前3个月内曾住院。108例患者符合纳入研究的条件；58例归类为内科入院患者，50例为外科入院患者。根据ACCP定义的标准，29例（50%）内科患者和38例（76%）外科患者被确定为VTE风险增加。在首次住院期间，只有三分之一的高危患者接受了ACCP推荐的预防措施。接受推荐预防措施的外科患者比内科患者多，尽管这在统计学上无显著差异（37%对24%，p = 0.3，Fisher精确检验）。
大量高危患者在出院后发生了VTE，但在首次住院期间未接受适当的血栓预防措施。实施国家和地方策略以改善住院患者血栓预防措施的使用，可能有助于减轻VTE的负担。
