Kocher Barbara, Darbellay Farhoumand Pauline, Pulver Damiana, Kopp Basil, Choffat Damien, Tritschler Tobias, Vollenweider Peter, Reny Jean-Luc, Rodondi Nicolas, Aujesky Drahomir, Méan Marie, Baumgartner Christine
Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Division of General Internal Medicine, Department of Medicine, Geneva University Hospitals (HUG), Geneva, Switzerland.
Res Pract Thromb Haemost. 2023 Aug 23;7(6):102184. doi: 10.1016/j.rpth.2023.102184. eCollection 2023 Aug.
Thromboprophylaxis (TPX) prescription is recommended in medical inpatients categorized as high risk of venous thromboembolism (VTE) by validated risk assessment models (RAMs), but how various RAMs differ in categorizing patients in risk groups, and whether the choice of RAM influences estimates of appropriate TPX use is unknown.
To determine the proportion of medical inpatients categorized as high or low risk according to validated RAMs, and to investigate the appropriateness of TPX prescription.
This is a prospective cohort study of acutely ill medical inpatients from 3 Swiss university hospitals. Participants were categorized as high or low risk of VTE by validated RAMs (ie, the Padua, the , simplified, and original Geneva scores). We assessed prescription of any TPX at baseline. We considered TPX prescription in high-risk and no TPX prescription in low-risk patients as appropriate.
Among 1352 medical inpatients, the proportion categorized as high risk ranged from 29.8% with the score to 66.1% with the original Geneva score. Overall, 24.6% were consistently categorized as high risk, and 26.3% as low risk by all 4 RAMs. Depending on the RAM used, TPX prescription was appropriate in 58.7% to 63.3% of high-risk (ie, 36.7%-41.3% underuse) and 52.4% to 62.8% of low-risk patients (ie, 37.2%-47.6% overuse).
The proportion of medical inpatients considered as high or low VTE risk varied widely according to different RAMs. Only half of patients were consistently categorized in the same risk group by all RAMs. While TPX remains underused in high-risk patients, overuse in low-risk patients is even more pronounced.
对于经有效风险评估模型（RAMs）判定为静脉血栓栓塞症（VTE）高风险的内科住院患者，推荐进行血栓预防（TPX）处方，但不同的RAMs在将患者分类到风险组方面有何差异，以及RAMs的选择是否会影响适当使用TPX的估计尚不清楚。
根据有效RAMs确定内科住院患者被分类为高风险或低风险的比例，并调查TPX处方的适当性。
这是一项对来自3家瑞士大学医院的急性病内科住院患者进行的前瞻性队列研究。通过有效RAMs（即帕多瓦评分、简化版和原版日内瓦评分）将参与者分类为VTE高风险或低风险。我们在基线时评估了任何TPX的处方情况。我们认为高风险患者使用TPX处方以及低风险患者不使用TPX处方是适当的。
在1352名内科住院患者中，被分类为高风险的比例从使用[此处缺失具体评分名称]评分时的29.8%到使用原版日内瓦评分时的66.1%不等。总体而言，所有4种RAMs均将24.6%的患者一致分类为高风险，26.3%的患者一致分类为低风险。根据所使用的RAMs，58.7%至63.3%的高风险患者（即36.7%-41.3%未充分使用）以及52.4%至62.8%的低风险患者（即37.2%-47.6%过度使用）的TPX处方是适当的。
根据不同的RAMs，被视为VTE高风险或低风险的内科住院患者比例差异很大。所有RAMs仅将一半的患者一致分类到相同的风险组。虽然高风险患者中TPX仍然使用不足，但低风险患者中的过度使用更为明显。
