Rosenman Marc, Liu Xianchen, Phatak Hemant, Qi Rong, Teal Evgenia, Nisi Daniel, Liu Larry Z, Ramacciotti Eduardo
1Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN; 2Regenstrief Institute, Indianapolis, IN; 3Global Health Economics and Outcomes Research, Pfizer, Inc., New York, NY; 4Bristol-Myers Squibb Co., Lawrenceville, NJ; and 5Department of Public Health, Weill Medical College of Cornell University, New York, NY.
Am J Ther. 2016 Mar-Apr;23(2):e328-35. doi: 10.1097/01.mjt.0000433945.70911.7c.
Patients hospitalized with acute medical illness have an elevated risk of venous thromboembolism (VTE). American College of Chest Physicians guidelines list various chronic illnesses, sepsis, advanced age, history of VTE, and immobility as risk factors and recommend prophylactic anticoagulation using fondaparinux, low-molecular weight heparin, or low-dose unfractionated heparin. The objectives of this study were to examine pharmacological prophylaxis against VTE among hospitalized medically ill patients and to assess demographic and clinical correlates related to VTE prophylaxis. A retrospective (1999-2010) electronic medical records study included patients aged 40 years and older hospitalized for at least 3 days, with significant medical illness or with a VTE hospitalization 30-365 days before admission. Each patient's first qualifying hospitalization was analyzed. Exclusions were if VTE treatment was started within 1 day of admission, or if warfarin (and not heparin or enoxaparin) was used. Prophylaxis was defined if the first inpatient dose of subcutaneous heparin or enoxaparin was at prophylaxis levels (lower than treatment levels). Multivariable logistic regression was used to examine factors associated with VTE prophylaxis. Among 12,980 patients, 22.1% received prophylaxis (11.8% with enoxaparin, 10.3% with heparin). VTE prophylaxis was positively associated with year of hospitalization, subcutaneous heparin in the month before admission, aspirin, self-pay status, age, and sepsis. VTE prophylaxis was negatively associated with smoking, alcohol, warfarin in the past 30 days, and primary diagnoses of stroke, infectious disease, or inflammatory bowel disease. Pharmacological VTE prophylaxis has increased significantly over the past 12 years but is still largely underused in patients hospitalized with acute medical illness. Multiple demographic, behavioral, and clinical factors are associated with inpatient VTE prophylaxis.
因急性内科疾病住院的患者发生静脉血栓栓塞症（VTE）的风险升高。美国胸科医师学会指南将各种慢性疾病、脓毒症、高龄、VTE病史和活动受限列为风险因素，并推荐使用磺达肝癸钠、低分子量肝素或小剂量普通肝素进行预防性抗凝治疗。本研究的目的是探讨内科疾病住院患者中预防VTE的药物治疗情况，并评估与VTE预防相关的人口统计学和临床因素。一项回顾性（1999 - 2010年）电子病历研究纳入了年龄在40岁及以上、住院至少3天、患有严重内科疾病或在入院前30 - 365天因VTE住院的患者。分析了每位患者的首次符合条件的住院情况。排除标准为入院1天内开始VTE治疗，或使用华法林（而非肝素或依诺肝素）。如果皮下注射肝素或依诺肝素的首次住院剂量处于预防水平（低于治疗水平），则定义为进行了预防。采用多变量逻辑回归分析与VTE预防相关的因素。在12980例患者中，22.1%接受了预防治疗（11.8%使用依诺肝素，10.3%使用肝素）。VTE预防与住院年份、入院前1个月皮下注射肝素、阿司匹林、自费状态、年龄和脓毒症呈正相关。VTE预防与吸烟、饮酒、过去30天内使用华法林以及中风、传染病或炎症性肠病的主要诊断呈负相关。在过去12年中，药物性VTE预防显著增加，但在急性内科疾病住院患者中仍大量未得到充分应用。多种人口统计学、行为和临床因素与住院患者的VTE预防相关。
