Departamento de Medicina Interna, Clínica Universidad de Navarra, Madrid, España.
Área de Urgencias, Hospital Clinic, IDIBAPS, Barcelona, España.
Emergencias. 2024 Aug;36(4):271-280. doi: 10.55633/s3me/051.2024.
To estimate the prevalence of inappropriate use of prophylaxis to prevent venous thromboembolism (VTE) in patients with medical diseases admitted to hospital from the emergency department. To explore variables associated with inappropriate thromboprophylaxis.
Prospective multicenter cohort study in 15 hospital emergency departments. We included patients admitted for a medical condition during 7 days in the first quarter of 2022. We assessed risk for VTE with the Padua Prediction Score (PPS). Inappropriate thromboprophylaxis was defined by failure to prescribe prophylaxis in patients with a high-risk PPS assessment unless there were absolute contraindications (active bleeding or severe thrombopenia) or, alternatively, the prescription of prophylaxis in patients with a low-risk PPS assessment or absolute contraindications. A logistic regression model was adjusted for risk level to identify variables associated with inappropriate use of thromboprophylaxis.
Of a total of 630 patients included, 450 (71.4%) had PPS scores indicating high risk for VTE; 180 patients were at low risk. Thromboprophylaxis was inappropriate in 248 patients (39.4%): 165 high-risk patients who received no prophylaxis, 82 low-risk patients who were nonetheless treated, and 1 patient who was treated in spite of severe thrombopenia. Odds ratios (ORs) revealed that the variables associated with inappropriate use of thromboprophylaxis were trauma or recent surgery (OR, 5.53; 95% CI, 1.58-19.34), presence of factors indicating risk for bleeding (OR, 2.61; 95% CI, 1.44-4.73), and hospital admission for either urinary tract infection (OR, 2.29; 95% CI, 1.07-4.87) or gastrointestinal disease (OR, 4.30; 95% CI, 1.71-10.85).
The inappropriate use of thromboprophylaxis in Spanish emergency departments is high and associated with certain clinical characteristics.
从急诊科入院的患有内科疾病的患者中估算预防静脉血栓栓塞（VTE）的预防用药的不适当使用的发生率。探讨与不适当血栓预防相关的变量。
在 15 家医院急诊部进行前瞻性多中心队列研究。我们纳入了 2022 年第一季度 7 天内因内科疾病入院的患者。我们使用帕多瓦预测评分（PPS）评估 VTE 的风险。如果高风险 PPS 评估的患者没有绝对禁忌症（活动性出血或严重血小板减少症），或者低风险 PPS 评估或绝对禁忌症的患者处方了预防用药，则定义为不适当的血栓预防。调整风险水平的逻辑回归模型用于识别与不适当使用血栓预防相关的变量。
在总共纳入的 630 名患者中，450 名（71.4%）患者的 PPS 评分提示 VTE 风险较高；180 名患者为低危。248 名患者（39.4%）的血栓预防不适当：165 名高风险患者未接受预防治疗，82 名低风险患者仍接受治疗，1 名尽管存在严重血小板减少症仍接受治疗。比值比（OR）显示，与不适当使用血栓预防相关的变量是创伤或近期手术（OR，5.53；95%CI，1.58-19.34）、存在出血风险因素（OR，2.61；95%CI，1.44-4.73）和因尿路感染（OR，2.29；95%CI，1.07-4.87）或胃肠道疾病（OR，4.30；95%CI，1.71-10.85）住院。
西班牙急诊部不适当使用血栓预防的情况较高，与某些临床特征有关。
