An update on the global use of risk assessment models and thromboprophylaxis in hospitalized patients with medical illnesses from the World Thrombosis Day steering committee: Systematic review and meta-analysis.
An update on the global use of risk assessment models and thromboprophylaxis in hospitalized patients with medical illnesses from the World Thrombosis Day steering committee: Systematic review and meta-analysis.
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DOI：
10.1111/jth.15607
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发表时间：
2022-03
影响因子：
10.4
通讯作者：
Barco, Stefano
中科院分区：
文献类型：
--
作者：
Forgo, Gabor;Micieli, Evy;Ageno, Walter;Castellucci, Lana A.;Cesarman-Maus, Gabriela;Ddungu, Henry;De Paula, Erich Vinicius;Dumantepe, Mert;Guillermo Esposito, Maria Cecilia;Konstantinides, Stavros V.;Kucher, Nils;McLintock, Claire;Ni Ainle, Fionnuala;Spyropoulos, Alex C.;Urano, Tetsumei;Hunt, Beverley J.;Barco, Stefano
静脉血栓栓塞（VTE）是心血管疾病发病和死亡的主要原因。大多数 VTE 事件与医院相关。 2008 年，国际流行病学日评估急性医院护理环境中存在静脉血栓栓塞风险的患者 (ENDORSE) 跨国横断面研究报告称，只有约 40% 存在 VTE 风险的内科患者接受了充分的血栓预防。在我们的系统评价和荟萃分析中，我们的目的是提供有关全球血栓预防使用情况的最新数据。我们重点关注：（a）根据个体模型有血栓预防指征的患者的频率； (b) 采用充分的血栓预防措施； (c) 报告了血栓预防的禁忌症。针对患病患者的观察性非随机研究或调查被认为是合格的。经过筛选后，我们纳入了来自 20 个国家/地区的 27 项研究，总共涉及 137 288 名患者。总体而言，50.5%（95%置信区间[CI]：41.9-59.1，I 2 99%）的患者有血栓预防的指征：其中，54.5%（95% CI：46.2-62.6，I 2 99%）接受了充分的血栓预防。充分预防血栓的比例在欧洲为 66.8%（95% CI：50.7–81.1，I 2 98%），在非洲为 44.9%（95% CI：31.8–58.4，I 2 96%），在亚洲为 37.6%（95% CI：25.7–50.3，I 2 97%），58.3%南美洲（95% CI：31.1–83.1，I 2 99%），北美为 68.6%（95% CI：64.9–72.6，I 2 96%）。不同风险评估模型在充分预防血栓的使用方面没有发现重大差异。出血、血小板减少症和肾/肝功能衰竭是最常报告的血栓预防禁忌症。使用抗凝剂预防 VTE 已被证明是有效和安全的，但在全球住院患者中，血栓预防处方仍然不能令人满意，且存在明显的地域差异。
Venous thromboembolism (VTE) is a leading cause of cardiovascular morbidity and mortality. The majority of VTE events are hospital‐associated. In 2008, the Epidemiologic International Day for the Evaluation of Patients at Risk for Venous Thromboembolism in the Acute Hospital Care Setting (ENDORSE) multinational cross‐sectional study reported that only approximately 40% of medical patients at risk of VTE received adequate thromboprophylaxis. In our systematic review and meta‐analysis, we aimed at providing updated figures concerning the use of thromboprophylaxis globally. We focused on: (a) the frequency of patients with an indication to thromboprophylaxis according with individual models; (b) the use of adequate thromboprophylaxis; and (c) reported contraindications to thromboprophylaxis. Observational nonrandomized studies or surveys focusing on medically ill patients were considered eligible. After screening, we included 27 studies from 20 countries for a total of 137 288 patients. Overall, 50.5% (95% confidence interval [CI]: 41.9–59.1, I 2 99%) of patients had an indication to thromboprophylaxis: of these, 54.5% (95% CI: 46.2–62.6, I 2 99%) received adequate thromboprophylaxis. The use of adequate thromboprophylaxis was 66.8% in Europe (95% CI: 50.7–81.1, I 2 98%), 44.9% in Africa (95% CI: 31.8–58.4, I 2 96%), 37.6% in Asia (95% CI: 25.7–50.3, I 2 97%), 58.3% in South America (95% CI: 31.1–83.1, I 2 99%), and 68.6% in North America (95% CI: 64.9–72.6, I 2 96%). No major differences in adequate thromboprophylaxis use were found across risk assessment models. Bleeding, thrombocytopenia, and renal/hepatic failure were the most frequently reported contraindications to thromboprophylaxis. The use of anticoagulants for VTE prevention has been proven effective and safe, but thromboprophylaxis prescriptions are still unsatisfactory among hospitalized medically ill patients around the globe with marked geographical differences.
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影响因子：
4
作者：
Germini, Federico;Agnelli, Giancarlo;Becattini, Cecilia
通讯作者：
Becattini, Cecilia
影响因子：
--
作者：
Lanthier, L.;Bechard, D.;Touchette, M.
通讯作者：
Touchette, M.
影响因子：
2.1
作者：
Lukaszuk, Robert F.;Plens, Krzysztof;Undas, Anetta
通讯作者：
Undas, Anetta
影响因子：
6.7
作者：
Mahan, Charles E.;Liu, Yang;Spyropoulos, Alex C.
通讯作者：
Spyropoulos, Alex C.
影响因子：
3.7
作者：
Dugani S;Gaziano TA
通讯作者：
Gaziano TA