Penn State Hershey Inflammatory Bowel Disease Center, Penn State College of Medicine, Hershey, PA, United States; Division of Gastroenterology and Hepatology, Penn State Hershey Medical Center, Hershey, PA, United States.
J Crohns Colitis. 2013 Dec;7(12):e635-40. doi: 10.1016/j.crohns.2013.05.002. Epub 2013 May 22.
Inflammatory bowel disease (IBD) patients are at increased risk for venous thromboembolism (VTE) compared to the general population. Practice guidelines recommend pharmacologic prophylaxis for IBD inpatients.
Our aim was to determine the rates of pharmacologic VTE prophylaxis in ulcerative colitis (UC) inpatients at a tertiary referral center. We also assessed potential predictors of pharmacologic prophylaxis.
We conducted a retrospective cohort study of 377 UC patients between January 1st, 2007 and December 31st, 2011. The medical record of each patient was examined to determine whether pharmacologic VTE prophylaxis was ordered and administered. We conducted multiple logistic regression to determine predictors of pharmacologic prophylaxis.
The overall VTE pharmacologic prophylaxis rate was 67.6%. The rate of patients admitted to the medical service was 57.4% compared to 93.5% for those admitted to surgery. In medical patients who received pharmacologic VTE prophylaxis, 34.0% of ordered doses were not given compared to 17.4% of doses in surgical patients (P<0.001). In the multiple logistic regression analysis, having an additional VTE risk factor (OR 2.46, 95% CI 1.41-4.30), extensive colitis (OR 2.26, 95% CI 1.32-3.87) or being admitted to a surgical service (OR 12.03, 95% CI 5.29-27.38) was associated with VTE pharmacologic prophylaxis.
A substantial proportion of medical patients admitted with UC were not ordered for VTE pharmacologic prophylaxis despite current guidelines. Even in patients who were ordered for pharmacologic prophylaxis, one third of doses were not given. Inappropriate prophylaxis may lead to unnecessary morbidity and mortality.
与普通人群相比，炎症性肠病（IBD）患者发生静脉血栓栓塞（VTE）的风险增加。临床实践指南建议对住院的 IBD 患者进行药物预防血栓。
我们旨在确定在一家三级转诊中心，溃疡性结肠炎（UC）住院患者中药物 VTE 预防的比率。我们还评估了药物预防的潜在预测因素。
我们对 2007 年 1 月 1 日至 2011 年 12 月 31 日期间的 377 例 UC 患者进行了回顾性队列研究。检查每位患者的病历，以确定是否开了并给予了药物 VTE 预防。我们进行了多项逻辑回归分析，以确定药物预防的预测因素。
总体 VTE 药物预防率为 67.6%。接受药物预防的患者中，内科患者占 57.4%，而外科患者占 93.5%。在接受药物 VTE 预防的内科患者中，有 34.0%的开处方剂量未给予，而外科患者中只有 17.4%的剂量未给予（P<0.001）。在多项逻辑回归分析中，存在其他 VTE 风险因素（OR 2.46，95%CI 1.41-4.30）、广泛性结肠炎（OR 2.26，95%CI 1.32-3.87）或被收入外科病房（OR 12.03，95%CI 5.29-27.38）与 VTE 药物预防相关。
尽管有现行指南，但仍有相当一部分因 UC 住院的内科患者未被开具 VTE 药物预防。即使给患者开了药物预防，也有三分之一的剂量未给予。不适当的预防可能导致不必要的发病率和死亡率。
