Department of Medicine, University of Queensland, Brisbane, Queensland, Australia.
Intern Med J. 2013 May;43(5):560-6. doi: 10.1111/imj.12033.
Venous thromboembolism (VTE) represents a major public health problem in Australia and worldwide, contributing to hundreds of thousands of deaths each year.
To assess adherence to recommended guidelines in a range of clinical settings.
Retrospective, observational study of 955 medical (M), surgical (S) and orthopaedic (O) patient charts of all M, S and O patients admitted during March 2011. Patients on warfarin were excluded from the analysis. Appropriate or inappropriate prophylaxis was assessed according to high, medium and low risk stratification. Patient risk stratification for VTE, suitability of prophylaxis given, adverse events and length of stay were recorded.
Nine hundred and thirteen eligible patients were assessed, 54% male, mean age 57 ± 21 years. Regarding the 372 M patients, 235 (63%) were on appropriate prophylaxis, compared with 84% (273/326) S and 78% (168/215) O patients (M to S, P < 0.0001; M to O, P = 0.0002; S to O, P = 0.113). High risk prevalence was 56% in M, 9% in S and 12% in O patients (P < 0.0001). Nine confirmed or possible VTE events occurred (seven M, with five of these on inappropriate prophylaxis). All three bleeding events (one fatal) were in M patients, two of whom had appropriate prophylaxis. Average length of stay was 4.1 ± 5.0, 2.1 ± 3.3 and 2.1 ± 3.8 days (P < 0.001) for M, S and O patients respectively.
Better adherence to prophylaxis guidelines is required, especially in M patients where the prevalence of high-risk VTE is greater.
静脉血栓栓塞症（VTE）是澳大利亚和全球范围内的一个主要公共卫生问题，每年导致数十万人死亡。
评估在一系列临床环境中对推荐指南的依从性。
对 2011 年 3 月期间所有 M、S 和 O 患者住院的 955 例 M、S 和 O 患者的病历进行回顾性、观察性研究。排除使用华法林的患者。根据高、中、低风险分层评估适当或不适当的预防措施。记录患者 VTE 风险分层、给予的预防措施是否合适、不良事件和住院时间。
评估了 913 例合格患者，其中 54%为男性，平均年龄 57 ± 21 岁。在 372 例 M 患者中，235 例（63%）接受了适当的预防措施，而 S 组为 84%（273/326），O 组为 78%（168/215）（M 与 S 比较，P < 0.0001；M 与 O 比较，P = 0.0002；S 与 O 比较，P = 0.113）。M 患者的高危患病率为 56%，S 患者为 9%，O 患者为 12%（P < 0.0001）。发生了 9 例确诊或可能的 VTE 事件（7 例 M 患者，其中 5 例预防措施不适当）。所有 3 例出血事件（1 例致命）均发生在 M 患者中，其中 2 例预防措施适当。M、S 和 O 患者的平均住院时间分别为 4.1 ± 5.0、2.1 ± 3.3 和 2.1 ± 3.8 天（P < 0.001）。
需要更好地遵守预防措施指南，特别是在 VTE 高危患病率较高的 M 患者中。
