Gharaibeh Lubna, Albsoul-Younes Abla, Younes Nidal
Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, University of Jordan, Amman, Jordan.
Department of Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, University of Jordan, Amman, Jordan
Clin Appl Thromb Hemost. 2016 Oct;22(7):627-32. doi: 10.1177/1076029615575344. Epub 2015 Mar 9.
Venous thromboembolism (VTE) is the most common preventable cause of hospital death; the burden of VTE includes the management of the acute event (deep vein thrombosis [DVT]/pulmonary embolism) and the chronic subsequents such as postthrombotic syndrome and recurrent DVT. All experts agree that despite the abundance of knowledge available on VTE and how to prevent it, it is still underused, and since the first step in prophylaxis is to identify those who are at high risk of VTE, several risk assessment models have been developed to identify these patients and provide appropriate prophylaxis. In our study, the institutional guideline in a tertiary educational hospital is the Caprini score (2006), a comparison was conducted between the institutional guideline and the American College of Chest Physicians guideline (ACCP ninth edition [ACCP-9]) in terms of the degree of agreement of the actual prophylaxis with the institutional guideline and the ACCP-9 and the differences in risk levels. The concordance with the ACCP-9 guideline was higher than with the institutional guideline, specifically in those patients receiving prophylaxis, and there was an overestimation of the risk levels in the institutional guideline, especially in medical patients. The replacement of the existing Caprini-2006 with the ACCP-9 is prudent, since it agrees with the physicians' clinical judgment and may result in reduced use of pharmacologic prophylaxis which could lead to lower costs and fewer adverse effects.
静脉血栓栓塞症（VTE）是医院死亡最常见的可预防原因；VTE的负担包括急性事件（深静脉血栓形成[DVT]/肺栓塞）的管理以及诸如血栓后综合征和复发性DVT等慢性后遗症。所有专家都一致认为，尽管关于VTE及其预防方法已有丰富的知识，但它仍未得到充分利用，而且由于预防的第一步是识别VTE高危人群，因此已开发了几种风险评估模型来识别这些患者并提供适当的预防措施。在我们的研究中，一家三级教学医院的机构指南是Caprini评分（2006年），就实际预防措施与机构指南和美国胸科医师学会指南（ACCP第九版[ACCP-9]）的一致程度以及风险水平差异，对机构指南和ACCP指南进行了比较。与ACCP-9指南的一致性高于机构指南，特别是在接受预防措施的患者中，并且机构指南中存在风险水平高估的情况，尤其是在内科患者中。用ACCP-9取代现有的Caprini-2006是明智的，因为它与医生的临床判断相符，并且可能会减少药物预防措施的使用，这可能会降低成本并减少不良反应。
