Kaatz Scott, Spyropoulos Alex C
Department of Medicine, Henry Ford Hospital, Detroit, MI, USA.
Hosp Pract (1995). 2011 Aug;39(3):7-15. doi: 10.3810/hp.2011.08.574.
Deep vein thrombosis and pulmonary embolism, the common clinical manifestations of venous thromboembolism (VTE), are among the most preventable complications of hospitalized patients. However, survey data repeatedly show poor rates of compliance with guideline-based preventive strategies. This has led the Centers for Medicare and Medicaid Services to deny reimbursement for hospital readmission for thromboembolic complications in patients undergoing total hip or knee arthroplasty. Multiple strategies and national initiatives have been developed to improve rates of VTE prophylaxis during hospitalization; however, most VTE occurs in the outpatient setting. Epidemiologic data suggest that recent surgery or hospitalization is a strong risk factor for the development of VTE and that this risk may persist for up to 6 months. These observations call into question whether VTE prophylaxis should be administered only during hospitalization or if this preventive strategy should be continued after hospital discharge. Many of the randomized trials showing efficacy of VTE prophylaxis have used longer durations of prophylaxis than are typical for current length of hospital stay, highlighting the issue of how long the duration of prophylaxis should be. Several patient groups have undergone formal testing to evaluate the risks and benefits of extended-duration VTE prophylaxis, but this issue is less clear for other categories of patients. Although there is clear consensus that most hospitalized patients should receive VTE prophylaxis, there is uncertainty about whether to continue VTE prophylaxis in the immediate post-hospital period or for an extended duration. The transition from inpatient to outpatient care is a key event in the coordination of continuity of care, but VTE-specific care transition guidance is limited. In this article, we review the evidence for both standard- and extended-duration VTE prophylaxis and discuss the difficulties in effectively maintaining VTE prophylaxis during the transition from inpatient to outpatient care.
深静脉血栓形成和肺栓塞是静脉血栓栓塞症（VTE）的常见临床表现，是住院患者中最可预防的并发症之一。然而，调查数据反复显示，基于指南的预防策略的依从率很低。这导致医疗保险和医疗补助服务中心拒绝为接受全髋关节或膝关节置换术的患者因血栓栓塞并发症再次住院提供报销。已经制定了多种策略和国家倡议来提高住院期间VTE预防的比率；然而，大多数VTE发生在门诊环境中。流行病学数据表明，近期手术或住院是发生VTE的一个强烈危险因素，而且这种风险可能持续长达6个月。这些观察结果使人质疑VTE预防是否仅应在住院期间进行，或者这种预防策略在出院后是否应继续。许多显示VTE预防有效的随机试验使用的预防持续时间比当前住院时间的典型持续时间更长，这突出了预防持续时间应为多长的问题。几个患者群体已经接受了正式测试，以评估延长VTE预防的风险和益处，但对于其他类别的患者，这个问题尚不清楚。虽然明确的共识是大多数住院患者应接受VTE预防，但对于在出院后立即或延长时间继续进行VTE预防仍存在不确定性。从住院治疗向门诊治疗的过渡是协调连续护理的关键事件，但针对VTE的护理过渡指导有限。在本文中，我们回顾了标准和延长持续时间的VTE预防的证据，并讨论了在从住院治疗向门诊治疗过渡期间有效维持VTE预防的困难。
