内科和外科住院患者的 VTE 风险特征和预防：中国住院患者静脉血栓栓塞症风险特征的识别（DissolVE-2）-一项横断面研究。
VTE Risk Profiles and Prophylaxis in Medical and Surgical Inpatients: The Identification of Chinese Hospitalized Patients' Risk Profile for Venous Thromboembolism (DissolVE-2)-A Cross-sectional Study.
机构信息
Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, No. 2 Yinghua Dongjie, Hepingli, Beijing, China.
Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Henan, China.
出版信息
Chest. 2019 Jan;155(1):114-122. doi: 10.1016/j.chest.2018.09.020. Epub 2018 Oct 6.
BACKGROUND
Limited data exist on VTE risk and prophylaxis in Chinese inpatients. The Identification of Chinese Hospitalized Patients' Risk Profile for Venous Thromboembolism-2 (DissolVE-2), a nationwide, multicenter, cross-sectional study, was therefore designed to investigate prevalence of VTE risks and evaluate VTE prophylaxis implementation compliant with the latest prophylaxis guidelines (American College of Chest Physicians [CHEST], 9th edition).
METHODS
Adults admitted (≥ 72 h) to 60 urban, tertiary Chinese hospitals due to acute medical conditions or surgery from March to September 2016 were assessed for VTE risk. Risk assessments were made by using the Padua Prediction Scoring or Caprini Risk Assessment model, risk factors, and prophylaxis based on the CHEST guidelines, 9th edition.
RESULTS
A total of 13,609 patients (6,986 surgical and 6,623 medical) were analyzed. VTE risk in surgical inpatients was categorized as low (13.9%; 95% CI, 13.1-14.7), moderate (32.7%; 95% CI, 31.6-33.8), and high (53.4%; 95% CI, 52.2-54.6); risk in medical patients was categorized as low (63.4%; 95% CI, 62.2-64.6) and high (36.6%; 95% CI, 35.4-37.8). Major risk factors in surgical and medical patients were major open surgery (52.6%) and acute infection (42.2%), respectively. Overall rate of any prophylaxis and appropriate prophylactic method was 14.3% (19.0% vs 9.3%) and 10.3% (11.8% vs 6.0%) in surgical and medical patients.
CONCLUSIONS
A large proportion of hospitalized patients reported VTE risk and low rate of CHEST-recommended prophylaxis. The data highlight the insufficient management of VTE risk and show the great potential for improving physicians' awareness and current practices across China.
TRIAL REGISTRY
Chinese Clinical Trial Registry; No.: ChiCTR-OOC-16010187; URL: http://www.chictr.org.cn/showproj.aspx?proj=17077.
背景
在中国住院患者中，有关静脉血栓栓塞症（VTE）风险和预防的相关数据十分有限。因此，“中国住院患者静脉血栓栓塞症风险评估-2（DissolVE-2）”这项全国多中心横断面研究旨在评估 VTE 风险的流行情况，并评估与最新预防指南（美国胸科医师学会[CHEST]，第 9 版）相符的 VTE 预防实施情况。
方法
2016 年 3 月至 9 月，因急性内科疾病或外科手术入住 60 家城市三级医院且住院时间超过 72 小时的成年患者，对其进行 VTE 风险评估。使用 Padua 预测评分或 Caprini 风险评估模型、危险因素以及基于 CHEST 指南第 9 版的预防措施，对患者进行风险评估。
结果
共分析了 13609 例患者（6986 例外科手术患者和 6623 例内科患者）。外科手术患者的 VTE 风险分类为低危（13.9%；95%CI，13.1%-14.7%）、中危（32.7%；95%CI，31.6%-33.8%）和高危（53.4%；95%CI，52.2%-54.6%）；内科患者的 VTE 风险分类为低危（63.4%；95%CI，62.2%-64.6%）和高危（36.6%；95%CI，35.4%-37.8%）。外科和内科患者的主要危险因素分别为大型开放性手术（52.6%）和急性感染（42.2%）。外科和内科患者接受任何预防治疗和合适预防方法的总体比例分别为 14.3%（19.0%比 9.3%）和 10.3%（11.8%比 6.0%）。
结论
很大比例的住院患者存在 VTE 风险，且 CHEST 推荐的预防治疗率较低。该数据突显了对 VTE 风险的管理不足，并表明提高中国医生的认识和当前实践水平具有巨大潜力。
试验注册
中国临床试验注册中心；注册号：ChiCTR-OOC-16010187；网址：http://www.chictr.org.cn/showproj.aspx?proj=17077。
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