Physician practices in the management of venous thromboembolism: a community-wide survey.
Physician practices in the management of venous thromboembolism: a community-wide survey.
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医生治疗静脉血栓栓塞的实践：一项社区范围的调查。
DOI：
10.1067/mva.1992.41080
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发表时间：
1992
影响因子：
4.3
通讯作者：
Wheeler,HB
中科院分区：
文献类型：
--
作者：
AndersonJr,FA;Wheeler,HB
虽然有一个广泛的共识，最佳的方法来管理静脉血栓栓塞症，有很少的数据，以评估遵守这些建议的程度。因此，在马萨诸塞州中部的16家短期住院医院进行了一项社区范围的研究，以评估静脉血栓栓塞的临床管理。根据经验证的出院诊断代码，从1988年7月1日至1989年12月31日的18个月期间，有1231例临床确认的静脉血栓栓塞病例，占148，730例出院病例的0.8%。81%的研究患者入院时有急性静脉血栓栓塞的体征或症状。97%的患者接受肝素、华法林或下腔静脉滤器治疗。89%的患者接受了静脉注射肝素（平均推注6674 IU;平均持续时间6.6天）。肝素给药后，开始华法林治疗平均延迟2.3天。假设住院时间相应缩短，通过更早开始口服抗凝治疗可以实现可观的成本节约。14%的患者置入下腔静脉滤器。在2%的患者中，治疗期间出现了临床公认的静脉血栓栓塞院内复发。尽管非教学医院推荐治疗方案的依从率略低，尽管下腔静脉滤器的使用频率较低，但10家非教学医院与6家教学医院相比，临床确认的静脉血栓栓塞的院内复发率无显著差异。在这项社区范围的研究中观察到的短期患者结局似乎与主要学术健康中心的对照临床试验报告相似。虽然这些患者的长期结局尚不确定，但似乎对持续存在静脉血栓栓塞风险的个体提供门诊预防治疗，可以最好地进一步降低静脉血栓栓塞的发病率和死亡率。（J Vasc Surg1992;16：707-14.）
Although there is a broad consensus on the optimum approach to the management of venous thromboembolism, there are few data from which to assess the extent of compliance with these recommendations. A community-wide study was therefore conducted in 16 short-stay hospitals in central Massachusetts to assess the clinical management of venous thromboembolism. Based on validated discharge diagnostic codes, there were 1231 clinically recognized cases of venous thromboembolism, 0.8% of 148,730 discharges in the 18-month period from July 1, 1988, to December 31, 1989. Eighty-one percent of study patients were admitted with signs or symptoms of acute venous thromboembolism. Ninety-seven percent of patients were treated with either heparin, warfarin, or inferior vena caval filter. Intravenous heparin was given to 89% of patients (mean bolus 6674 IU; mean duration 6.6 days). After heparin administration, there was a mean delay of 2.3 days in starting warfarin. Assuming a corresponding decrease in the length of hospital stay, appreciable cost savings could have been realized by earlier start of oral anticoagulation. An inferior vena cava filter was placed in 14% of patients. There was a clinically recognized in-hopsital recurrence of venous thromboembolism during treatment in 2% of patients. Despite a slightly lower rate of compliance with recommended treatment regimens in nonteaching hospitals, and despite less frequent use of the inferior vena cava filter, there was no significant difference in the rate of in-hospital recurrence of clinically recognized venous thromboembolism in 10 nonteaching hospitals compared with six teaching hospitals. Short-term patient outcomes observed in this community-wide study appear similar to those reported in controlled clinical trials in major academic health centers. Although long-term outcomes are uncertain in these patients, it appears that further reduction in the morbidity and mortality rates of venous thromboembolism may best be achieved by providing outpatient prophylaxis for individuals at continuing risk for venous thromboembolism. (J Vasc Surg1992;16:707–14.)