Blondon Marc, Limacher Andreas, Righini Marc, Aujesky Drahomir, Méan Marie
Division of Angiology and Hemostasis Geneva University Hospitals and Faculty of Medicine Geneva Switzerland.
CTU Bern University of Bern Bern Switzerland.
Res Pract Thromb Haemost. 2020 Nov 6;5(1):142-147. doi: 10.1002/rth2.12361. eCollection 2021 Jan.
Hospital-associated venous thromboembolism (HA-VTE) can be prevented by pharmacologic thromboprophylaxis. Thrombotic risk assessment models (RAMs) are essential tools to improve inadequately prescribed thromboprophylaxis. Among cases of HA-VTE, our study objectives are to explore the classifications of available thrombosis RAMs, the adequacy of thromboprophylaxis and risk factors for inadequate thromboprophylaxis.
We identified cases of HA-VTE occurring during medical hospitalizations within a multicenter Swiss venous thromboembolism (VTE) cohort (2009-2013). We calculated the proportion of VTE cases deemed at high risk with 4 VTE RAMs (Geneva, Simplified Geneva, Padua, and Improve) and the adequacy of administered pharmacologic thromboprophylaxis, and explored risk factors for underprescription of thromboprophylaxis in high-risk inpatients.
Among 66 medical inpatients with HA-VTE, 60.6% had pulmonary embolism. The sensitivities of the Geneva, Simplified Geneva, Padua, and Improve RAMs were 86.4%, 80.3%, 72.7%, and 57.6%, respectively. The proportion of inadequate thromboprophylaxis was high, as 62.5%-71.1% of high-risk inpatients had not received it. Among the high-risk group according to the Simplified Geneva RAM, absence of immobilization was the only variable significantly associated with an inadequate use of thromboprophylaxis (odds ratio, 3.59; 95% confidence interval, 1.08-11.88).
We found a dramatically high proportion of inadequate medical thromboprophylaxis among inpatients who suffered from HA-VTE. This reinforces the need for global and local quality-improvement efforts to promote adequate use of thromboprophylaxis in elderly inpatients. Mobility may favor the underuse of thromboprophylaxis, and clinicians should stay alert to other thrombotic risk factors in mobile inpatients.
医院相关性静脉血栓栓塞症（HA-VTE）可通过药物性血栓预防措施加以预防。血栓形成风险评估模型（RAMs）是改善血栓预防措施处方不当问题的重要工具。在HA-VTE病例中，我们的研究目的是探讨现有血栓形成RAMs的分类、血栓预防措施的充分性以及血栓预防措施不足的危险因素。
我们在一个多中心瑞士静脉血栓栓塞症（VTE）队列（2009 - 2013年）中确定了内科住院期间发生的HA-VTE病例。我们用4种VTE RAMs（日内瓦模型、简化日内瓦模型、帕多瓦模型和Improve模型）计算了被视为高危的VTE病例比例以及所给予的药物性血栓预防措施的充分性，并探讨了高危住院患者血栓预防措施处方不足的危险因素。
在66例患有HA-VTE的内科住院患者中，60.6%发生了肺栓塞。日内瓦模型、简化日内瓦模型、帕多瓦模型和Improve模型的敏感性分别为86.4%、80.3%、72.7%和57.6%。血栓预防措施不足的比例很高，因为62.5% - 71.1%的高危住院患者未接受该措施。在简化日内瓦模型定义的高危组中，未制动是唯一与血栓预防措施使用不足显著相关的变量（比值比，3.59；95%置信区间，1.08 - 11.88）。
我们发现，在患有HA-VTE的住院患者中，药物性血栓预防措施不足的比例极高。这强化了全球和地方为促进老年住院患者充分使用血栓预防措施而进行质量改进努力的必要性。活动能力可能导致血栓预防措施使用不足，临床医生应警惕活动患者中的其他血栓形成危险因素。
