Fritz Megan Kunka, Kincaid Scott E, Sargent Charles G, Green Amanda H, Davis George A
Pharmacy Department, University of Kentucky HealthCare, 800 Rose Street, Lexington, KY, 40536-0293, USA.
Pharmacy Department, University of Kentucky HealthCare, 800 Rose Street, Room H-110, Lexington, KY, 40536-0293, USA.
J Thromb Thrombolysis. 2021 Jan;51(1):67-73. doi: 10.1007/s11239-020-02144-1.
Hospital-acquired venous thromboembolism (VTE) is still a concern for general medical patients. Pharmacologic prophylaxis can reduce VTE incidence, but there is the potential for adverse effects. Therefore, determining which patients should receive VTE prophylaxis via risk scoring tools is essential. Limited evidence exists for the ideal venous thromboembolism risk assessment model (RAM) in hospitalized medical patients, as compared to other hospitalized patient subgroups such as surgical patients. The primary objective was to investigate the utilization and appropriateness of our institution-based VTE RAM and comparison to the Padua Prediction Score (PPS). This would allow for a gauge of provider risk assessment accuracy as well as appropriate predictive potential of the PPS or whether an alternative to the PPS should be considered. A total of 330 adult general medicine patients were included in this retrospective chart review. When compared to our institution-based VTE RAM, providers predominately stratified patients at a higher VTE risk than the institution-based VTE RAM. VTE incidence was 0.3%, which was lower than predicted. Significant discordance exists between providers' VTE risk assessment and that predicted by RAMs. Our institution-based VTE RAM appears comparable to PPS; however, it was not being utilized by providers, resulting in potentially unnecessary use of pharmacologic prophylaxis. The most appropriate venous thromboembolism risk assessment model for general medicine patients is undetermined. Our providers generally assess patients as moderate or high VTE risk, despite our institution-based RAM which typically recommends a lower risk category than provider selection. Because of provider risk assessment, more patients received pharmacologic VTE prophylaxis than would have been recommended by the RAM, which might correlate to the low incidence of VTE which was < 0.5%, although bleeding complications were not assessed in this study. A prospective study utilizing the Padua Prediction Score (or similar RAM) in general medicine patients is warranted in order to decipher the best method of predicting VTE risk.
医院获得性静脉血栓栓塞症（VTE）仍是普通内科患者面临的一个问题。药物预防可降低VTE发生率，但存在不良反应的可能性。因此，通过风险评分工具确定哪些患者应接受VTE预防至关重要。与手术患者等其他住院患者亚组相比，关于住院内科患者理想的静脉血栓栓塞症风险评估模型（RAM）的证据有限。主要目的是调查我们基于机构的VTE RAM的使用情况和适用性，并与帕多瓦预测评分（PPS）进行比较。这将有助于衡量医疗人员风险评估的准确性以及PPS的适当预测潜力，或者是否应考虑PPS的替代方案。这项回顾性病历审查共纳入了330名成年普通内科患者。与我们基于机构的VTE RAM相比，医疗人员将患者分层为VTE风险高于基于机构的VTE RAM的情况占多数。VTE发生率为0.3%，低于预期。医疗人员的VTE风险评估与RAM预测之间存在显著不一致。我们基于机构的VTE RAM似乎与PPS相当；然而，医疗人员并未使用它，导致药物预防可能存在不必要的使用。普通内科患者最合适的静脉血栓栓塞症风险评估模型尚未确定。尽管我们基于机构的RAM通常推荐的风险类别低于医疗人员的选择，但我们的医疗人员通常将患者评估为中度或高度VTE风险。由于医疗人员的风险评估，接受药物VTE预防的患者比RAM推荐的更多，这可能与VTE发生率低（<0.5%）有关，尽管本研究未评估出血并发症。有必要对普通内科患者进行一项使用帕多瓦预测评分（或类似RAM）的前瞻性研究，以确定预测VTE风险的最佳方法。
