Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA; Department of Medicine, University of Vermont Medical Center, Burlington, Vermont, USA.
Department of Medical Biostatistics, University of Vermont, Burlington, Vermont, USA.
J Thromb Haemost. 2024 Dec;22(12):3521-3531. doi: 10.1016/j.jtha.2024.08.016. Epub 2024 Sep 12.
Although guidelines recommend risk assessment for hospital-acquired venous thromboembolism (HA-VTE) to inform prophylaxis decisions, studies demonstrate inappropriate utilization of pharmacoprophylaxis in hospitalized medical patients. Predictors of pharmacoprophylaxis initiation in medical inpatients remain largely unknown.
To determine factors associated with HA-VTE pharmacoprophylaxis initiation in adults hospitalized on medical services.
We performed a cohort study using electronic health record data from adult patients hospitalized on medical services at 4 academic medical centers between 2016 and 2019. Main measures were candidate predictors of HA-VTE pharmacoprophylaxis initiation, including known HA-VTE risk factors, predicted HA-VTE risk, and bleeding diagnoses present on admission.
Among 111 550 admissions not on intermediate or full-dose anticoagulation, 48 520 (43.5%) received HA-VTE pharmacoprophylaxis on the day of or the day after admission. After adjustment for age, sex, race/ethnicity, and study site, the strongest clinical predictors of HA-VTE pharmacoprophylaxis initiation were malnutrition and chronic obstructive pulmonary disease. Thrombocytopenia and history of gastrointestinal bleeding were associated with decreased odds of HA-VTE pharmacoprophylaxis initiation. Patients in the highest 2 tertiles of predicted HA-VTE risk were less likely to receive HA-VTE pharmacoprophylaxis than patients in the lowest (first) tertile (OR, 0.84; 95% CI, 0.81-0.86 for the second tertile; OR, 0.95; 95% CI, 0.92-0.98 for the third tertile).
Among patients not already receiving anticoagulants, HA-VTE pharmacoprophylaxis initiation during the first 2 hospital days was lower in patients with a higher predicted HA-VTE risk and those with risk factors for bleeding. Reasons for not initiating pharmacoprophylaxis in those with a higher predicted HA-VTE risk could not be assessed.
尽管指南建议对医院获得性静脉血栓栓塞症（HA-VTE）进行风险评估，以告知预防决策，但研究表明，在住院的内科患者中，药物预防的使用不当。内科住院患者开始药物预防的预测因素在很大程度上尚不清楚。
确定与在 4 家学术医疗中心的内科住院患者中发生 HA-VTE 药物预防相关的因素。
我们使用了来自于 2016 年至 2019 年期间在 4 家学术医疗中心的内科住院患者的电子健康记录数据进行了队列研究。主要措施是 HA-VTE 药物预防开始的候选预测因素，包括已知的 HA-VTE 风险因素、预测的 HA-VTE 风险和入院时存在的出血诊断。
在 111550 例未接受中剂量或全剂量抗凝治疗的入院患者中，有 48520 例（43.5%）在入院当天或次日接受了 HA-VTE 药物预防。在调整年龄、性别、种族/族裔和研究地点后，HA-VTE 药物预防开始的最强临床预测因素是营养不良和慢性阻塞性肺疾病。血小板减少症和胃肠道出血史与 HA-VTE 药物预防开始的可能性降低相关。预测的 HA-VTE 风险最高的 2 个 tertile 的患者接受 HA-VTE 药物预防的可能性低于风险最低的（第一） tertile 的患者（第 2 tertile 的 OR，0.84；95%CI，0.81-0.86；第 3 tertile 的 OR，0.95；95%CI，0.92-0.98）。
在未接受抗凝治疗的患者中，在入院后的前 2 天内，预测 HA-VTE 风险较高的患者和有出血风险因素的患者开始 HA-VTE 药物预防的比例较低。对于预测 HA-VTE 风险较高的患者未开始药物预防的原因尚无法评估。
