Department of Medicine, "Azienda Ulss 15 Alta Padovana," Cittadella, Padova, Italy.
Department of Cardiovascular Sciences, University of Padova, Padova, Italy.
Semin Thromb Hemost. 2017 Jul;43(5):460-468. doi: 10.1055/s-0036-1597901. Epub 2017 Feb 6.
Deep vein thrombosis and pulmonary embolism are associated with considerable morbidity and mortality in hospitalized patients, accounting for up to 10% of hospitalization-related deaths in both surgical and medical patients. Pharmacologic thromboprophylaxis has been demonstrated to be effective, safe, and cost-effective in preventing hospital-acquired venous thromboembolism (VTE) among medical inpatients, and clinician awareness of thrombotic risk promotes prescription of thromboprophylaxis. Guidelines recommend stratification of thrombotic risk for all patients and, unless contraindicated, administration of VTE prophylaxis. Based on several recognized predisposing and exposing risk factors for VTE, several scoring systems have been published in the past 15 years. Borrowing models developed in the surgical setting, recognized risk factors for VTE complications in medical inpatients have been combined in different weighted scores and derived and validated in heterogeneous medical populations. Although the perfect score, balancing thrombotic and hemorrhagic risk, has probably not yet been built, the adoption of an easy-to-use risk assessment model has the potential to support physicians in properly stratifying VTE risk in medical inpatients, tailoring thromboprophylaxis prescription.
深静脉血栓形成和肺栓塞与住院患者的发病率和死亡率密切相关，在外科和内科住院患者中，高达 10%的住院相关死亡与它们有关。药物血栓预防已被证明在预防住院患者获得性静脉血栓栓塞症（VTE）方面是有效、安全且具有成本效益的，临床医生对血栓形成风险的认识促进了血栓预防的处方。指南建议对所有患者进行血栓形成风险分层，并在无禁忌证的情况下使用 VTE 预防措施。基于过去 15 年来已确定的 VTE 的几个易患和暴露风险因素，已经发表了几种评分系统。借鉴外科环境中开发的模型，将内科住院患者 VTE 并发症的公认风险因素结合在不同的加权评分中，并在异质的内科人群中进行推导和验证。尽管可能尚未构建出完美的评分，以平衡血栓形成和出血风险，但采用易于使用的风险评估模型有可能帮助医生正确分层内科住院患者的 VTE 风险，并调整血栓预防的处方。
