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急性后期护理患者静脉血栓栓塞症的发生率及预测因素。一项前瞻性队列研究。

Incidence and predictors of venous thromboembolism in post-acute care patients. A prospective cohort study.

机构信息

Internal Medicine, Cà Foncello Hospital, Treviso, Italy.

出版信息

Thromb Haemost. 2010 Oct;104(4):734-40. doi: 10.1160/TH10-03-0169. Epub 2010 Jul 20.

Abstract

Few studies have addressed the topic of venous thromboembolism (VTE) in patients hospitalised in rehabilitation facilities. This patient population is rapidly growing, and data aimed to better define VTE risk in this setting are needed. Primary aim of this prospective observational study was to evaluate the frequency of symptomatic, objectively confirmed VTE in a cohort of unselected consecutive patients admitted to rehabilitation facilities, after medical diseases or surgery. Further objectives were to assess overall mortality, to identify risk factors for VTE and mortality, and to assess the attitude of physicians towards thromboprophylaxis. A total of 3,039 patients were included in the study, and the median duration of hospitalisation was 26 days. Seventy-two patients (2.4%) had symptomatic VTE. The median time to VTE from admission to the long-term care unit was 13 days. According to multivariable analysis, previous VTE (hazard ratio 5.67, 95% confidence interval 3.30-9.77) and cancer (hazard ratio 2.26, 95% confidence interval 1.36-3.75) were significantly associated to the occurrence of VTE. Overall in-hospital mortality was 15.1%. Age over 75 years, male gender, disability, cancer, and the absence of thromboprophylaxis were significantly associated to an increased risk of death (multivariable analysis). In-hospital antithrombotic prophylaxis was administered to 75.1% of patients, and low-molecular-weight heparin was the most widely used agent. According to our study, patients admitted to rehabilitation facilities remain at substantially increased risk for VTE. Because this applies to the majority of these patients, there is a great need for clinical trials assessing optimal prophylactic strategies.

摘要

很少有研究探讨过在康复机构住院的患者中的静脉血栓栓塞症(VTE)这一主题。该患者群体正在迅速增长,需要数据来更好地定义这种情况下的 VTE 风险。这项前瞻性观察研究的主要目的是评估在接受医疗疾病或手术后被送入康复设施的未经选择的连续患者队列中,症状性、客观证实的 VTE 的频率。进一步的目标是评估总体死亡率,确定 VTE 和死亡率的危险因素,并评估医生对血栓预防的态度。共有 3039 名患者纳入研究,住院中位数为 26 天。72 名患者(2.4%)出现症状性 VTE。从入院到长期护理病房的 VTE 中位时间为 13 天。根据多变量分析,既往 VTE(风险比 5.67,95%置信区间 3.30-9.77)和癌症(风险比 2.26,95%置信区间 1.36-3.75)与 VTE 的发生显著相关。总体院内死亡率为 15.1%。年龄大于 75 岁、男性、残疾、癌症和无血栓预防与死亡风险增加显著相关(多变量分析)。75.1%的患者接受了院内抗血栓预防治疗,低分子肝素是最广泛使用的药物。根据我们的研究,入住康复机构的患者仍然面临着显著增加的 VTE 风险。由于大多数患者都有这种情况,因此非常需要评估最佳预防策略的临床试验。

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