Ferreira Bruno Ávila, Danielian Pedro Luiz Lage Bodour, Caetano Geovanna Cota, Ferreira Cássia Rodrigues Lima, de Oliveira Maria Aparecida, Colosimo Enrico Antônio, de Bastos Marcos, Rezende Suely Meireles
Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Hospital Governador Israel Pinheiro, Belo Horizonte, Minas Gerais, Brazil.
Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
Thromb Res. 2024 Nov;243:109145. doi: 10.1016/j.thromres.2024.109145. Epub 2024 Sep 5.
Hospital-acquired venous thromboembolism (VTE) is a major cause of preventable deaths. Incidence of VTE and adequacy of thromboprophylaxis have rarely been reported in low-resourced countries. The aim of this study was to estimate the incidence of VTE and to evaluate the adequacy of thromboprophylaxis in acutely-ill medical hospitalized patients.
The PROFMiG is a prospective cohort study conducted in Brazil. We consecutively enrolled adult (> 18 years) acutely-ill hospitalized medical patients at admission. Risk assessment for VTE was evaluated by the IMPROVE7 (International Medical Prevention Registry on Venous Thromboembolism). Outcomes were death and VTE events during hospital stay up to 90 days after discharge. All VTE and death events were adjudicated. We also evaluated pulmonary embolism-related death and adequacy of thromboprophylaxis. VTE incidence was estimated by competing risk methods.
A total of 2380 participants was included. Median age was 70 years, 56.1 % women, median length of hospital stay was 10 days. A total of 2052 (86.3 %) patients were classified as low-risk for VTE, 30 (1.3 %) patients had objectively confirmed VTE, and 1449 (60.8 %) received inadequate thromboprophylaxis. The overall mortality rate was 14.0 %. Cumulative incidence of VTE was 2.0 % (95 % confidence interval 0.9 %-3.8 %) at 130 days after admission when considering death as competing risk.
The cumulative incidence of VTE in this cohort corroborates with that reported in high-resourced countries. Despite recommendation, thromboprophylaxis was mostly inadequate. We suggest the adoption of competing risk analysis to estimate the cumulative incidence of VTE in hospitalized patients.
医院获得性静脉血栓栓塞症（VTE）是可预防死亡的主要原因。资源匮乏国家很少报告VTE的发病率和血栓预防的充分性。本研究的目的是估计VTE的发病率，并评估急性病住院内科患者血栓预防的充分性。
PROFMiG是在巴西进行的一项前瞻性队列研究。我们在入院时连续纳入成年（>18岁）急性病住院内科患者。通过IMPROVE7（国际静脉血栓栓塞症医学预防登记处）评估VTE的风险。结局为出院后90天内住院期间的死亡和VTE事件。所有VTE和死亡事件均进行判定。我们还评估了肺栓塞相关死亡和血栓预防的充分性。通过竞争风险方法估计VTE发病率。
共纳入2380名参与者。中位年龄为70岁，女性占56.1%，中位住院时间为10天。共有2052名（86.3%）患者被归类为VTE低风险，30名（1.3%）患者经客观证实发生VTE，1449名（60.8%）患者接受的血栓预防不充分。总死亡率为14.0%。将死亡视为竞争风险时，入院后130天VTE的累积发病率为2.0%（95%置信区间0.9%-3.8%）。
该队列中VTE的累积发病率与资源丰富国家报告的发病率相符。尽管有相关推荐，但血栓预防大多不充分。我们建议采用竞争风险分析来估计住院患者VTE的累积发病率。
