Rocha Diana, Lobato Carolina Tintim, Melo Pinto Diogo, Marques Francisca, Marques Tatiana, Guedes Carolina
Internal Medicine, Hospital Pedro Hispano, Matosinhos, PRT.
Intensive Care Unit, Hospital Pedro Hispano, Matosinhos, PRT.
Cureus. 2023 Nov 26;15(11):e49444. doi: 10.7759/cureus.49444. eCollection 2023 Nov.
Venous thromboembolism (VTE) includes pulmonary embolism (PE), deep vein thrombosis (DVT) in lower limbs, and thrombosis in rare locations. VTE is a common cardiovascular disease, being the leading preventable cause of in-hospital death. Both surgical and acute medical patients have an elevated risk of developing VTE. VTE risk assessment is essential to identify patients who might benefit from VTE prophylaxis accurately. Clinical data on risk factors and prophylaxis in Portugal are scarce. We aimed to determine the proportion of at-risk patients who received prophylaxis and the incidence of bleeding events. We also intended to study the rate of VTE in a cohort of medical and surgical patients during the hospitalization period and three months after discharge.
During one week in 2020, adults admitted for more than 72hr to a medical or surgical ward were included. The study excluded patients with a diagnosis of VTE three months before hospitalization and who were either chronically receiving anticoagulation therapy or had started it 48 hours after admission. Risk assessments were based on the Padua Prediction Score (PPS) for medical patients and the Caprini Risk Assessment Model (CRAM) for surgical patients. We used CHEST guidelines, 9th edition, to determine the adequacy of the prophylactic method.
A total of 123 patients were analyzed, 18.7% of which tested positive for SARS-CoV-2. VTE risk in surgical patients was categorized as very low or low (16.6%), moderate (37.5%), and high (43.8%), according to the CRAM. Risk in medical patients was categorized as low (60.0%) or high (40.0%) according to the PPS. We estimated that VTE chemoprophylaxis was overused in about 30.0% of patients vs. 7.0% who were at risk and did not receive appropriate chemoprophylaxis. The rate of thromboembolic events was 4.1% (n=5), 2 of which happened after discharge. Two of these patients were under VTE prophylaxis during hospitalization. Major bleeding occurred in 2.4% of patients (n=3).
A significant number of hospitalized patients are deemed to be at risk for VTE, making appropriate prophylaxis essential. The results emphasize the insufficient management of VTE prophylaxis.
静脉血栓栓塞症（VTE）包括肺栓塞（PE）、下肢深静脉血栓形成（DVT）以及罕见部位的血栓形成。VTE是一种常见的心血管疾病，是住院患者可预防死亡的主要原因。外科手术患者和急性内科患者发生VTE的风险均有所升高。VTE风险评估对于准确识别可能从VTE预防中获益的患者至关重要。葡萄牙关于风险因素和预防措施的临床数据匮乏。我们旨在确定接受预防措施的高危患者比例以及出血事件的发生率。我们还打算研究一组内科和外科患者在住院期间及出院后三个月内的VTE发生率。
纳入2020年某一周内入住内科或外科病房超过72小时的成年患者。该研究排除了住院前三个月被诊断为VTE的患者，以及长期接受抗凝治疗或入院48小时后开始抗凝治疗的患者。风险评估基于内科患者的帕多瓦预测评分（PPS）和外科患者的卡普里尼风险评估模型（CRAM）。我们采用第9版《CHEST指南》来确定预防方法的适当性。
共分析了123例患者，其中18.7%的患者新型冠状病毒检测呈阳性。根据CRAM，外科患者的VTE风险分为极低或低风险（16.6%）、中度风险（37.5%）和高风险（43.8%）。根据PPS，内科患者的风险分为低风险（60.0%）或高风险（40.0%）。我们估计，约30.0%的患者VTE化学预防用药过度，而7.0%有风险但未接受适当化学预防的患者则未得到预防。血栓栓塞事件发生率为4.1%（n = 5），其中2例发生在出院后。这些患者中有2例在住院期间接受了VTE预防。2.4%的患者（n = 3）发生了大出血。
大量住院患者被认为有VTE风险，因此适当的预防措施至关重要。结果强调了VTE预防管理的不足。
