Nguyen Anthony T, Glaeser Alexandra M
Internal Medicine, University of California Los Angeles, Los Angeles, USA.
Cureus. 2024 Oct 19;16(10):e71866. doi: 10.7759/cureus.71866. eCollection 2024 Oct.
Pharmacologic venous thromboembolism (VTE) prophylaxis is effective and essential in the inpatient setting for medically ill patients to prevent deep venous thromboses (DVTs) and pulmonary embolisms (PEs), especially in high-risk patients such as those with limited mobility and underlying malignancy. It is less clear how the primary team, including the nurses and physicians, work together to ensure adherence to VTE prophylaxis during hospitalizations, especially amongst different institutions with varied practices. This case series describes two cases of healthcare-associated VTE after refusal of VTE prophylaxis for several days and the resulting complications, including morbidity and mortality. In light of these two cases and recognition that healthcare-associated VTE is a wider public health problem, we suggest a multi-disciplinary and standardized protocol for physicians to follow to ensure VTE prophylaxis adherence that takes into account a VTE risk assessment calculator such as the Padua or Caprini scores. Furthermore, physicians should acknowledge VTE prophylaxis refusal, counsel patients, and document their findings in high-risk patients on a daily basis. This would be a full-circle approach that encourages patient education about this commonplace yet critical practice and the potential consequences of non-adherence.
药物性静脉血栓栓塞症（VTE）预防对于内科疾病患者住院期间预防深静脉血栓形成（DVT）和肺栓塞（PE）是有效且必要的，尤其是对于行动不便和患有潜在恶性肿瘤等高危患者。目前尚不清楚包括护士和医生在内的一线团队如何共同努力，以确保患者在住院期间坚持进行VTE预防，特别是在不同机构且做法各异的情况下。本病例系列描述了两例在拒绝VTE预防数天后发生的医疗相关VTE病例以及由此产生的并发症，包括发病率和死亡率。鉴于这两个病例以及认识到医疗相关VTE是一个更广泛的公共卫生问题，我们建议医生遵循一个多学科的标准化方案，以确保坚持进行VTE预防，该方案应考虑到VTE风险评估计算器，如帕多瓦或卡普里尼评分。此外，医生应承认患者拒绝VTE预防，为患者提供咨询，并每天记录高危患者的情况。这将是一个全面的方法，鼓励患者了解这种常见但关键的做法以及不坚持预防的潜在后果。
