Omnicare, Inc, Livonia, MI 48150, USA.
J Am Med Dir Assoc. 2010 Mar;11(3):211-21. doi: 10.1016/j.jamda.2009.11.006. Epub 2010 Feb 4.
Hospitalized patients and residents of long-term care (LTC) facilities account for about 60% of all cases of venous thromboembolism (VTE), as incidence is correlated with increasing age, immobility, and underlying medical conditions. The primary aim of the study was to develop an evidence-based VTE risk stratification tool and definition of immobility for residents in LTC facilities.
Using the Delphi process, a panel of vascular thrombotic and geriatric experts reviewed and ranked statements of VTE risk and immobility derived from randomized controlled trials, meta-analyses, cohort trials, case-control trials, and case series to arrive at consensus for the importance of each statement. Rating was conducted before and during an on-site meeting following discussion. Statements rated high and very high were used to develop a VTE risk stratification and immobility tool.
A total of 1165 publications related to VTE risk were identified from which 137 (12%) pertained to subjects with a median age of 60 years or older; 42 (31%) met study criteria. Eight (29.6%) of 79 publications pertaining to immobility met study criteria. There were 4 studies related to VTE risk and 1 to immobility that were rated as high quality. VTE risk factors were age older than 60 years, active cancer, acute infectious disease, catheter in a central vein, chronic obstructive pulmonary disease, dehydration, history of VTE, having a first-degree relative with VTE, heart failure, hypercoagulable state, immobility, inflammatory bowel disease, obesity, rheumatoid arthritis and treatment with erythroid stimulating agents to a hemoglobin value greater than 12 g/dL, aromatase inhibitor, hormone replacement therapy, megestrol acetate, or selective estrogen receptor modulators. Immobility was defined as the presence of at least 1 of the following: being bedridden or bedridden except for bathroom privileges, unable to walk at least 10 feet, recent reduction in ability to walk at least 10 feet for at least 72 hours, and having a lower limb cast.
A risk stratification tool for VTE and immobility was developed to assist clinicians in caring for residents of LTC facilities. A prospective trial is needed to validate the tool.
静脉血栓栓塞症（VTE）患者中约有 60%为住院患者和长期护理机构（LTC）的居民，其发病率与年龄增长、活动受限和潜在疾病相关。本研究的主要目的是为 LTC 机构的居民开发一种基于证据的 VTE 风险分层工具和活动受限定义。
使用德尔菲法，一组血管血栓形成和老年专家审查并对源自随机对照试验、荟萃分析、队列试验、病例对照试验和病例系列的 VTE 风险和活动受限相关的陈述进行排名，以确定每个陈述的重要性达成共识。在讨论后的现场会议之前和期间进行评分。评分高和非常高的陈述用于开发 VTE 风险分层和活动受限工具。
共从与 VTE 风险相关的 1165 篇文献中确定了 137 篇（12%）与中位年龄 60 岁或以上的受试者有关；其中 42 篇（31%）符合研究标准。与活动受限相关的 79 篇文献中有 8 篇（29.6%）符合研究标准。有 4 项与 VTE 风险相关的研究和 1 项与活动受限相关的研究被评为高质量。VTE 风险因素包括年龄大于 60 岁、活动性癌症、急性传染病、中心静脉导管、慢性阻塞性肺疾病、脱水、VTE 病史、一级亲属 VTE 病史、心力衰竭、高凝状态、活动受限、炎症性肠病、肥胖、类风湿关节炎和红细胞生成刺激剂治疗血红蛋白值大于 12g/dL、芳香酶抑制剂、激素替代疗法、甲地孕酮或选择性雌激素受体调节剂。活动受限定义为存在以下至少 1 种情况：卧床或仅在有上厕所的特权时离开床、至少 72 小时内无法行走至少 10 英尺、最近至少 72 小时内行走至少 10 英尺的能力下降、下肢打石膏。
开发了一种 VTE 和活动受限的风险分层工具，以帮助临床医生照顾 LTC 机构的居民。需要进行前瞻性试验来验证该工具。
