依诺肝素预防内科住院患者血栓栓塞的有效性和安全性。

Effectiveness and safety of thromboprophylaxis with enoxaparin in medical inpatients.

机构信息

Internal Medicine Service, Hospital Universitario Príncipe de Asturias. Alcalá de Henares, Madrid, Spain.

出版信息

Thromb Res. 2011 Nov;128(5):440-5. doi: 10.1016/j.thromres.2011.07.042. Epub 2011 Aug 30.

DOI:10.1016/j.thromres.2011.07.042

PMID:21880352

Abstract

BACKGROUND

Venous thromboembolism (VTE) includes deep vein thrombosis and pulmonary embolism. Although effective prophylaxis exists for medical patients, there is little information outside of clinical trials. We will analyze our experience in the prophylaxis of VTE with enoxaparin in hospitalized medical patients.

MATERIAL AND METHODS

We studied all of the patients ≥15 years admitted for emergency care to all of the medical departments of the hospital, except for the Hematology Department, between 1/April/1999 and 31/December/2005. The patients' age, sex, Charlson comorbidity index (CCI), whether they received prophylaxis with enoxaparin or not, dose, VTE, bleeding, thrombocytopenia, and mortality were analyzed.

RESULTS

40,349 patients were included, of which 55.87% were male, with an average age of 67.56, and an average CCI of 4.99. There were 19,834 patients who did not receive prophylaxis for which the rate of incidence of VTE was 0.61%, mortality 8.75%, bleeding 1.38%, and thrombocytopenia 0.04%. Prophylactic enoxaparin was administered to 20,515 patients, for which the rate of incidence of VTE was 0.44%, mortality 10.71%, bleeding 1.1%, and thrombocytopenia 0.04%. The adjusted Odds Ratio (OR) for VTE was 0.65 (95% confidence interval [95% CI] 0.49 to 0.87). The adjusted OR for mortality was 0.84 (95% CI 0.78 to 0.9). With the adjusted data, the number needed to treat (NNT) for VTE was 470.3 (95% CI 278.4 to 1413.3), and the NNT for mortality was 77.2 (95% CI 54.6 to 130.3).

CONCLUSION

Thromboprophylaxis with enoxaparin in hospitalized medical patients is associated with a lower incidence of VTE and mortality, and is safe.

摘要

背景

静脉血栓栓塞症（VTE）包括深静脉血栓形成和肺栓塞。虽然有针对医疗患者的有效预防措施，但临床试验之外的信息很少。我们将分析我们在使用依诺肝素预防住院医疗患者 VTE 方面的经验。

材料和方法

我们研究了 1999 年 4 月 1 日至 2005 年 12 月 31 日期间，除血液科外，所有急诊住院的所有内科患者，年龄≥15 岁。分析了患者的年龄、性别、Charlson 合并症指数（CCI）、是否接受依诺肝素预防、剂量、VTE、出血、血小板减少症和死亡率。

结果

共纳入 40349 例患者，其中 55.87%为男性，平均年龄为 67.56 岁，平均 CCI 为 4.99。有 19834 例患者未接受预防治疗，VTE 发生率为 0.61%，死亡率为 8.75%，出血率为 1.38%，血小板减少症发生率为 0.04%。20515 例患者接受了预防性依诺肝素治疗，VTE 发生率为 0.44%，死亡率为 10.71%，出血率为 1.1%，血小板减少症发生率为 0.04%。VTE 的调整后优势比（OR）为 0.65（95%置信区间[95%CI]为 0.49 至 0.87）。死亡率的调整后 OR 为 0.84（95%CI 为 0.78 至 0.9）。根据调整后的数据，VTE 的需要治疗人数（NNT）为 470.3（95%CI 为 278.4 至 1413.3），死亡率的 NNT 为 77.2（95%CI 为 54.6 至 130.3）。