Prevention of Venous Thromboembolism: Practice Patterns in 17 Geographically Diverse Long Term Care Facilities in the United States: Part 1 of 2 (an AMDA Foundation Project)
Prevention of Venous Thromboembolism: Practice Patterns in 17 Geographically Diverse Long Term Care Facilities in the United States: Part 1 of 2 (an AMDA Foundation Project)
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DOI：
10.1016/j.jamda.2011.04.016
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发表时间：
2012-03-01
影响因子：
7.6
通讯作者：
Norkus, Edward P.
中科院分区：
文献类型：
--
作者：
Dharmarajan, T. S.;Nanda, Aman;Norkus, Edward P.
目前的指南推荐抗血栓预防静脉血栓栓塞（VTE）使用风险评估，考虑禁忌症。本报告总结了目前在长期护理中预防静脉血栓栓塞的实践模式，作为一项3阶段教育干预研究的第一阶段。第一阶段参与者：参与者是来自17个地理位置不同的长期护理机构（3260张床位）的376名新入院/再入院患者（77 +/- 12 [SD]岁；67%为女性）。测量：该流程描述了目前静脉血栓栓塞预防（VTE- p）的做法；一篇配套文章描述了教育干预（第二阶段）和结果（第三阶段）。收集了2009年7月至9月间VTE-P使用非药物措施和抗血栓药物的1期数据。结果：85%的新入院患者有明显的VTE-P适应症，其中三分之二接受了VTE-P治疗。在54.8%的入院患者中观察到抗凝禁忌，包括生活质量或患者/护理人员的意愿。Logistic回归分析预测VTE-P的任何适应症或禁忌症与VTE-P的使用之间没有关系，这表明对当前临床实践指南的理解不足。结论：长期护理的住院患者有显著的合并症，存在静脉血栓栓塞的风险；尽管许多患者接受了VTE-P，但禁忌症是常见的，需要个体化考虑。在骨科手术、严重创伤和内科疾病后发生VTE-P的可能性最大。版权所有(C) 2012 -美国医学董事协会，Inc。
Introduction: Current guidelines recommend antithrombotic prophylaxis for venous thromboembolism (VTE) using risk assessment, factoring contraindications. This report represents a summary of current practice patterns to prevent VTE in long term care as Phase 1 of a 3-phase educational intervention study.Phase 1 Participants: Participants were 376 new admissions/readmissions (77 +/- 12 [SD] years; 67% female) from 17 geographically diverse long term care facilities (3260 total beds).Measurements: The process describes current VTE prophylaxis (VTE-P) practices; a companion article describes the educational intervention (Phase 2) and outcome (Phase 3). Phase 1 datawere collected on use of nonpharmacological measures and antithrombotic drugs for VTE-P between July and September 2009.Results: Indications for VTE-P were evident in 85% of new admissions, of which two-thirds received VTE-P. Contraindications for anticoagulation were observed in 54.8% of admissions, including quality of life or patient/caregiver wishes. Logistic regression analysis predicted no relationship between any indication for or any contraindication to VTE-P and use of VTE-P, suggesting an inadequate understanding of current clinical practice guidelines.Conclusions: Residents of long term care have significant comorbidity that poses risk for VTE; although many received VTE-P, contraindications were common, warranting individualized considerations. The likelihood of VTE-P was greatest following orthopedic surgery, severe trauma, and medical illness. Copyright (C) 2012 - American Medical Directors Association, Inc.