STATinMED Research and The University of Michigan, Ann Arbor, MI, USA.
Thromb J. 2011 Oct 13;9(1):15. doi: 10.1186/1477-9560-9-15.
To assess the incidence of venous thromboembolism (VTE) and bleeding events with or without thromboprophylaxis and the associated costs in a cohort of medically ill patients in both in-hospital and outpatient settings.
A large hospital drug database and linked outpatient files were used to identify patients eligible for this analysis, based on demographic and clinical characteristics.
Among 11,135 patients identified, 1592 (14.30%) were admitted with chronic heart failure, 1684 (15.12%) with thromboembolic stroke, 3834 (34.43%) with severe lung disease, 1658 (14.89%) with acute infection, and 2367 (21.26%) with cancer. Of the 11,135 patients, 5932 received anticoagulant therapy at some point during their hospitalization and until 30 days after discharge. VTE events occurred in 1.30% of patients who received anticoagulant prophylaxis versus 2.99% of patients who did not. Risk-adjusted total healthcare costs for patients with a VTE or major or minor bleeding event were significantly higher than for those without events (VTE: $52,157 ± 24,389 vs $24,164 ± 11,418; major bleeding: $33,656 ± 18,196 vs $24,765 ± 11,974; minor bleeding: $33,690 ± 14,398 vs $23,610 ± 11,873). In a multivariate analysis, appropriate anticoagulant prophylaxis use was significantly associated with a reduced risk of clinical VTE, compared with no anticoagulant use (hazard ratio: 0.37). Patients admitted with thromboembolic stroke were less likely to have a VTE than patients admitted with cancer (hazard ratio: 0.42).
In this analysis, VTE and major bleeding event rates were lower for patients who received prophylaxis compared with those who did not. Prophylaxis use was associated with lower healthcare costs.
评估患有内科疾病的住院和门诊患者发生静脉血栓栓塞症（VTE）和出血事件的发生率，以及有无预防性使用抗栓药物及其相关成本。
利用大型医院药物数据库和相关门诊文件，根据人口统计学和临床特征，确定符合本分析条件的患者。
在确定的 11135 名患者中，1592 名（14.30%）因慢性心力衰竭入院，1684 名（15.12%）因血栓栓塞性脑卒中入院，3834 名（34.43%）因严重肺部疾病入院，1658 名（14.89%）因急性感染入院，2367 名（21.26%）因癌症入院。在这 11135 名患者中，5932 名患者在住院期间或出院后 30 天内接受了抗凝治疗。接受抗凝预防的患者 VTE 发生率为 1.30%，未接受抗凝预防的患者 VTE 发生率为 2.99%。发生 VTE 或大出血或小出血事件的患者的总医疗保健费用明显高于未发生事件的患者（VTE：52157 美元±24389 美元，33656 美元±18196 美元，33690 美元±14398 美元）。多变量分析显示，与未使用抗凝药物相比，适当使用抗凝预防药物可显著降低临床 VTE 风险（风险比：0.37）。与癌症患者相比，因血栓栓塞性脑卒中入院的患者发生 VTE 的可能性较低（风险比：0.42）。
在本分析中，与未接受预防治疗的患者相比，接受预防治疗的患者 VTE 和大出血事件的发生率较低。预防治疗的使用与较低的医疗保健成本相关。
