van Oosterom Nameer, De Guzman Keshia R, Winckel Karl, Johnson Anissa, Falconer Nazanin
University of Queensland, Brisbane, QLD, Australia.
Hosp Pharm. 2023 Dec;58(6):595-604. doi: 10.1177/00185787231172385. Epub 2023 May 20.
: Hospital acquired venous thromboembolisms (VTEs) are common and preventable. The Queensland Health VTE prophylaxis guidelines, developed in 2018, provide guidance for risk assessment, and prescribing of anticoagulation for prophylaxis and treatment of hospital inpatients. Currently, there are limited recommendations for gastroenterology patients. This study investigated the completion of VTE risk assessments, and the appropriateness of VTE prophylaxis regimens, in accordance with Queensland Health guidelines for gastroenterology patients. The quality and safety of VTE prophylaxis regimens was assessed based on their VTE risk and bleeding risk. : A retrospective study was conducted by obtaining a random sample of gastroenterology patients admitted to a tertiary Australian hospital, from 1st May 2019 and 1st May 2020, to determine the compliance of VTE risk assessment and thromboprophylaxis prescribing with state-wide VTE guidelines. The quality and safety of thromboprophylaxis was evaluated using the modified Caprini and HASBLED scores, and subsequent thromboprophylaxis-related complications. : Of the 94 patients reviewed, 68 did not have contraindications to thromboprophylaxis. Of these 68 patients, 32 (47%) had no VTE risk assessment recorded in their clinical records and were not prescribed any thromboprophylaxis during the hospitalization. There was no significant difference between thromboprophylaxis prescribing for patients with low VTE risk, compared to moderate to high VTE risk ( = .075). There was a trend for decrease in thromboprophylaxis prescribing as HASBLED bleeding risk score increased, and patients with moderate-high bleed risk were less likely to be prescribed thromboprophylaxis ( = .006). There were no thromboprophylaxis related complications identified. It is essential that all patients have a clearly documented risk assessment and are prescribed thromboprophylaxis according to best practice guidelines. The prescription of venous thromboembolism prophylaxis should continue to be individualized, with each patient assessed holistically.
医院获得性静脉血栓栓塞症（VTEs）很常见且可预防。2018年制定的昆士兰卫生VTE预防指南为住院患者的风险评估以及预防和治疗抗凝药物的处方提供了指导。目前，针对胃肠病患者的建议有限。本研究根据昆士兰卫生指南，调查了胃肠病患者VTE风险评估的完成情况以及VTE预防方案的适宜性。基于VTE风险和出血风险评估了VTE预防方案的质量和安全性。
通过从2019年5月1日至2020年5月1日在澳大利亚一家三级医院随机抽取胃肠病患者样本进行回顾性研究，以确定VTE风险评估和血栓预防处方与全州VTE指南的合规性。使用改良的Caprini和HASBLED评分以及随后的血栓预防相关并发症评估血栓预防的质量和安全性。
在审查的94例患者中，68例没有血栓预防的禁忌症。在这68例患者中，32例（47%）的临床记录中没有VTE风险评估记录，并且在住院期间未开具任何血栓预防药物。与中高VTE风险患者相比，低VTE风险患者的血栓预防处方没有显著差异（P = 0.075）。随着HASBLED出血风险评分增加，血栓预防处方有减少趋势，中高出血风险患者接受血栓预防处方的可能性较小（P = 0.006）。未发现与血栓预防相关的并发症。所有患者都必须有明确记录的风险评估，并根据最佳实践指南开具血栓预防药物。静脉血栓栓塞预防的处方应继续个体化，对每位患者进行全面评估。
