Hematology-Oncology Division, Department of Internal Medicine, American University of Beirut Medical Center, PO Box 11-0236, Riad El-Solh, 1107 2020 Beirut, Lebanon.
J Thromb Thrombolysis. 2011 Jan;31(1):47-56. doi: 10.1007/s11239-010-0492-2.
Venous thromboembolism (VTE) is a major public health issue that is frequently underestimated. The primary objective of this multinational survey was to identify patients at risk for VTE, and to define the rate of patients receiving appropriate prophylaxis in the Middle Eastern region. Standardized case report forms were filled by trained individuals on one predefined day in selected hospitals. Data were then entered and analyzed by independent biostatisticians. Risk was categorized according to American College of Chest Physicians (ACCP) guidelines, 2004. Logistic regressions were carried out to assess factors that determined VTE prophylaxis. 845 (37%) medical and 1421 (63%) surgical patients were eligible for the study. Patients were at low (4.2%), moderate (51.7%), high (9%) and very high risk (35.2%) for VTE. Any VTE prevention was given in 17.9, 41.7, 60.6 and 66.9% of respective risk categories, while ACCP guidelines were applied in 86.3, 41.1, 48.3 and 24.5% of these categories. Surgical patient type, immobility on admission, and contraceptive use were the most important drivers of VTE prophylaxis in those who were eligible to it (OR ≥ 2). Surgical patient type, immobility during hospitalization, existence of a VTE protocol and chronic heart failure were the most important drivers for VTE prophylaxis application in patients who were not eligible for it (OR ≥ 3). A concordance κ value of 0.16 was found between eligibility for VTE prophylaxis on one hand and its application in practice (P < 0.001). Risk factors for VTE and eligibility for VTE prophylaxis are common, but VTE prophylaxis and guidelines application are low.
静脉血栓栓塞症（VTE）是一个重大的公共卫生问题，但常常被低估。这项多国家调查的主要目的是确定 VTE 高危患者，并确定中东地区接受适当预防治疗的患者比例。在选定的医院中，经过培训的人员在一天内填写标准化病例报告表。然后由独立的生物统计学家输入和分析数据。风险根据美国胸科医师学会（ACCP）2004 年指南进行分类。进行逻辑回归分析，以评估确定 VTE 预防治疗的因素。845 名内科患者（37%）和 1421 名外科患者（63%）符合研究条件。患者 VTE 风险为低（4.2%）、中（51.7%）、高（9%）和极高（35.2%）。在相应风险类别中，分别有 17.9%、41.7%、60.6%和 66.9%的患者接受了任何 VTE 预防治疗，而在这些类别中，分别有 86.3%、41.1%、48.3%和 24.5%的患者遵循了 ACCP 指南。外科患者类型、入院时活动受限以及使用避孕药是有资格接受 VTE 预防治疗的患者中 VTE 预防治疗的最重要驱动因素（OR≥2）。外科患者类型、住院期间活动受限、存在 VTE 治疗方案以及慢性心力衰竭是无资格接受 VTE 预防治疗的患者中 VTE 预防治疗应用的最重要驱动因素（OR≥3）。VTE 预防治疗的资格与实践中应用 VTE 预防治疗之间的一致性κ值为 0.16（P<0.001）。VTE 风险因素和 VTE 预防治疗的资格很常见，但 VTE 预防治疗和指南应用率较低。
