Intermountain Medical Center, Department of Pharmacy, USA.
Intermountain Medical Center, Department of Trauma and Surgical Critical Care, USA.
Am J Surg. 2024 Feb;228:247-251. doi: 10.1016/j.amjsurg.2023.10.032. Epub 2023 Oct 14.
Risk of venous thromboembolism (VTE) in many trauma patients extends beyond hospitalization, but there is a paucity of evidence to guide the use of post-discharge prophylaxis (PDP).
A retrospective cohort study of trauma patients deemed moderate-to-high risk for VTE (risk assessment profile score [RAP] ≥5) who were prescribed PDP based on an internal clinical guideline assessing injury pattern and mobility status. PDP patients were compared with those that did not receive post-discharge prophylaxis (NPDP).
1512 patients were included. PDP group had higher mean RAP score (7.3 vs. 6.4, p < 0.001), more likely to have a complex orthopedic fracture and underwent a longer median hospital (4.7 vs. 2.9 days, p < 0.001). No difference between groups in 90-day VTE (11 [1.5 %] (PDP) vs. 8 [1.0 %] (NPDP), p = 0.50), clinically relevant bleeding (p = 0.58), or readmission (p = 0.46).
VTE incidence, clinically relevant bleeding, and readmission 90-days after hospital discharge were low and similar between PDP and NPDP groups. PDP prescribed in a presumably higher VTE risk trauma population may mitigate the long-term risk of VTE.
许多创伤患者的静脉血栓栓塞（VTE）风险超出了住院期，但缺乏指导出院后预防（PDP）使用的证据。
这是一项回顾性队列研究，纳入了被认为有中高度 VTE 风险（风险评估谱评分[RAP]≥5）的创伤患者，这些患者根据内部临床指南评估损伤模式和活动能力状态来开具 PDP。将 PDP 患者与未接受出院后预防（NPDP）的患者进行比较。
共纳入 1512 名患者。PDP 组的平均 RAP 评分更高（7.3 比 6.4，p<0.001），更有可能患有复杂的骨科骨折，并接受了更长的中位住院时间（4.7 比 2.9 天，p<0.001）。两组在 90 天 VTE（11 [1.5%]（PDP）与 8 [1.0%]（NPDP），p=0.50）、有临床意义的出血（p=0.58）或再入院（p=0.46）方面无差异。
出院后 90 天内 VTE 的发生率、有临床意义的出血和再入院率较低，且 PDP 组和 NPDP 组之间相似。在 VTE 风险较高的创伤人群中开具 PDP 可能会降低长期 VTE 的风险。
