Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy.
Department of Internal Medicine, Internal Medicine Unit, Maggiore Hospital, Bologna, Italy.
Mayo Clin Proc. 2019 Jan;94(1):37-43. doi: 10.1016/j.mayocp.2018.07.020.
To evaluate the effect of hospitalization on deep venous thrombosis (DVT) rate by the cumulative incidence of DVT in the proximal venous tract of the lower limbs at admission and discharge.
The AURELIO (rAte of venoUs thRombosis in acutEly iLl patIents hOspitalized in internal medicine wards) multicenter observational study was carried out in hospital-university internal medicine wards including consecutive acutely ill medical patients. Patients underwent compression ultrasonography (CUS) of proximal lower limb veins at admission and discharge. The occurrence of DVT was the primary end point of the study.
Among 1340 patients, 26 (1.9%; 95% CI, 1.3%-2.8%) had asymptomatic DVT at admission and were excluded. During the follow-up, 144 patients were excluded because of hospitalization less than 5 days. The remaining 1170 patients underwent a CUS at discharge. Two hundred fifty (21%) underwent prophylaxis with parenteral anticoagulants; the remaining 920 (79%) were not treated with anticoagulants. The mean length of hospitalization was 13±8 days. Compared with patients without prophylaxis, those treated with parenteral anticoagulants had a higher incidence of active cancer, heart and respiratory failure, pneumonia, renal failure, previous venous thromboembolism, reduced mobility, and elderly age. During the hospital stay, 3 patients with a negative CUS at admission experienced DVT in the proximal tract (0.025%, rate of 1 per 5017 patient-days); 2 of them were in prophylaxis with parenteral anticoagulants.
We provide evidence that in the real world acutely ill medical patients display more than 90% (1.9%) asymptomatic DVT at admission, whereas the intrahospital DVT occurrence is very low. This suggests a novel diagnostic workup and a careful reanalysis of anticoagulant prophylaxis.
通过比较下肢近端静脉血栓形成（DVT）患者在入院和出院时的累积 DVT 发生率，评估住院对 DVT 发生率的影响。
该多中心观察性研究 AURELIO（acute ill patients hospitalized in internal medicine wards 中 venous thrombosis rate）在医院-大学内科病房中进行，包括连续的急性内科患者。患者在入院和出院时接受下肢近端静脉加压超声检查（CUS）。研究的主要终点是 DVT 的发生。
在 1340 名患者中，26 名（1.9%；95%置信区间，1.3%-2.8%）在入院时患有无症状 DVT，被排除在外。在随访期间，有 144 名患者因住院时间少于 5 天而被排除。其余 1170 名患者在出院时接受了 CUS 检查。250 名（21%）接受了肠外抗凝剂预防治疗；其余 920 名（79%）未接受抗凝治疗。平均住院时间为 13±8 天。与未预防治疗的患者相比，接受肠外抗凝剂治疗的患者癌症活动期、心呼吸衰竭、肺炎、肾衰竭、既往静脉血栓栓塞、活动能力下降和高龄的发生率更高。在住院期间，3 名入院时 CUS 阴性的患者在近端部位发生 DVT（0.025%，每 5017 患者-天发生 1 例）；其中 2 例在接受肠外抗凝剂预防治疗。
我们提供的证据表明，在现实世界中，90%以上（1.9%）的急性内科患者在入院时患有无症状 DVT，而住院期间 DVT 的发生率非常低。这提示需要进行新的诊断检查，并仔细重新分析抗凝预防治疗。
