An evaluation of thromboembolism prophylaxis in acutely ill medical patients.
An evaluation of thromboembolism prophylaxis in acutely ill medical patients.
复制标题
急性内科患者血栓栓塞预防的评估。
DOI：
10.4414/smw.2002.10059
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发表时间：
2002
影响因子：
2.9
通讯作者：
H. Bounameaux
中科院分区：
文献类型：
--
作者：
Patricia Chmelik;P. Chopard;H. Bounameaux
研究的目的
检查在一级-三级保健医院住院的急病内科患者血栓预防的频率和充分性。
方法
我们对在日内瓦大学医院三个医疗机构住院的266名患者进行了横断面研究。排除等接受治疗性抗凝治疗的患者后，纳入202例。血栓预防的适当性通过法国巴黎拉里博伊西埃尔医院制定的明确标准进行评估。
结果
总体而言，87名患者(43.1%)接受了血栓预防。在明确标准的情况下，这一比例降至37.6%(p=0.25)。根据所使用的明确标准，大约一半的患者没有得到不必要的治疗，而本应接受治疗的患者中有42%没有得到治疗。Kappa系数评估的隐性标准(或观察到的治疗率)与显性标准之间的一致性为0.2。两种服务(A、B)过度使用血栓预防(p=0.002)，C服务倾向于血栓预防不足(p=0.45)。
结论
尽管应用的显性标准的适当性尚未得到彻底验证，但这些结果表明，隐含标准与相当大的不确定性有关，从而导致血栓预防的过度或不足。需要进一步的研究，以更好地了解急性疾病内科患者的血栓栓子危险因素，并为在这种情况下预防血栓制定明确的循证标准。
AIM OF THE STUDY
To examine the frequency and adequacy of thromboprophylaxis in acutely ill medical patients hospitalised in a primary-tertiary care hospital.
METHODS
We carried out a cross-sectional study of 266 patients hospitalised in the three medical services of the University Hospital of Geneva. After exclusion of patients (64) treated by therapeutic anticoagulation, 202 patients were included. The appropriateness of thromboprophylaxis was assessed by means of explicit criteria developed by the Hôpital Lariboisière, Paris, France.
RESULTS
Overall, 87 patients (43.1%) received thromboprophylaxis. With explicit criteria, this percentage decreased to 37.6% (p = 0.25). According to the explicit criteria used, about half of the patients were unnecessarily treated, whereas 42% of the patients who should have been treated were not. Agreement between implicit criteria (or observed treatment rate) and explicit criteria assessed by kappa coefficient is 0.2. Two services (A, B) had an overuse of thromboprophylaxis (p = 0.002) and service C tended to under-use thromboprophylaxis (p = 0.45).
CONCLUSION
Even though the appropriateness of the applied explicit criteria has not been thoroughly validated, these results suggest that implicit criteria are associated with considerable uncertainty leading to both over or under-use of thromboprophylaxis. Further research is needed to better understand thromboembolic risk factors in acutely ill medical patients and to elaborate explicit evidence-based criteria for thromboprophylaxis in this setting.