Bergmann Jean-François, Lloret-Linares Célia, Rami Agathe, Cohen Alexander T, Garay Ricardo P, Kakkar Ajay K, Goldhaber Samuel Z, Deslandes Bruno, Tapson Victor F, Anderson Frederick A
Université Paris-Diderot, AP-HP, hôpital Lariboisière, service médecine interne A, 75010 Paris, France.
Presse Med. 2011 Dec;40(12 Pt 1):e528-37. doi: 10.1016/j.lpm.2011.06.023. Epub 2011 Oct 2.
Information about the variation in the risk for venous thromboembolism (VTE) and in prophylaxis practices in France and around the world is scarce.
The Epidemiologic International Day for the Evaluation of Patients at Risk for Venous Thromboembolism in the Acute Hospital Care Setting (ENDORSE) study is a multinational cross-sectional survey designed to assess the prevalence of VTE risk in the acute hospital care setting, and to determine the proportion of at-risk patients who receive effective prophylaxis, in accordance with the 2004 American College of Chest Physicians (ACCP) guidelines. This paper gives the results of the ENDORSE study in the French centres in comparison with the global worldwide results of the ENDORSE study and with other Western Europe countries.
In France, 18 randomized hospitals participated to the study between august 2006 and January 2007. 2844 patients were evaluated (917 from chirurgical wards and 1927 from medical wards). One thousand four hundred and nineteen patients (49.9%) were at VTE risk (78.3% in chirurgical wards and 36.4% in medical wards). Of the 1419 patients at VTE risk, 62.4% received ACCP-recommended VTE prophylaxis (71.2% in chirurgical wards and 53.5% in medical wards). VTE Prophylaxis in France (62.4%) is more frequent than worldwide in the international ENDORSE study (50.2%) and similar to the majority of the other western European countries and the USA. It is also more used in university hospitals (66.9%) than in other hospitals (58.9%). Prophylaxis in patients at risk for VTE was presented in 43% patients with acute heart failure, 53% with non-infectious acute respiratory failure, 57% in patients with pulmonary infection, 56% in patients with stroke, 55% in patients with active cancer and 48% in patients with non-pulmonary sepsis.
The ENDORSE study has shown a high level of patients at risk for VTE in the population of hospitalized patients in France. The rate of prophylaxis for VTE remained low, in particular in Medicine wards. Our data reinforced the rationale for the use of hospital-wide strategies to assess patients' VTE risk and to implement measures that ensure that at-risk patients receive appropriate prophylaxis, in particularly in medical patients.
关于法国及全球静脉血栓栓塞症（VTE）风险变化及预防措施的信息匮乏。
急性医院护理环境中静脉血栓栓塞症风险患者评估的国际流行病学日（ENDORSE）研究是一项跨国横断面调查，旨在评估急性医院护理环境中VTE风险的患病率，并根据2004年美国胸科医师学会（ACCP）指南确定接受有效预防的高危患者比例。本文给出了法国中心ENDORSE研究的结果，并与ENDORSE研究的全球结果以及其他西欧国家进行了比较。
在法国，2006年8月至2007年1月期间有18家随机选择的医院参与了该研究。共评估了2844例患者（917例来自外科病房，1927例来自内科病房）。1419例患者（49.9%）存在VTE风险（外科病房为78.3%，内科病房为36.4%）。在1419例有VTE风险的患者中，62.4%接受了ACCP推荐的VTE预防措施（外科病房为71.2%，内科病房为53.5%）。法国的VTE预防措施使用率（62.4%）高于国际ENDORSE研究中的全球水平（50.2%），与大多数其他西欧国家和美国相似。在大学医院中（66.9%）的使用率也高于其他医院（58.9%）。VTE高危患者中，43%的急性心力衰竭患者、53%的非感染性急性呼吸衰竭患者、57%的肺部感染患者、56%的中风患者、55%的活动性癌症患者以及48%的非肺部脓毒症患者接受了预防措施。
ENDORSE研究表明，法国住院患者中VTE高危患者比例较高。VTE预防率仍然较低，尤其是在内科病房。我们的数据强化了采用全院范围策略评估患者VTE风险并实施确保高危患者接受适当预防措施的措施的合理性，特别是在内科患者中。
