Thromboprophylaxis rates in US medical centers: success or failure?
Thromboprophylaxis rates in US medical centers: success or failure?
复制标题
DOI：
10.1111/j.1538-7836.2007.02650.x
复制
发表时间：
2007-08-01
影响因子：
10.4
通讯作者：
Yang, G.
中科院分区：
文献类型：
--
作者：
Amin, A.;Stemkowski, S.;Yang, G.
背景：由于住院医疗患者可能有静脉血栓栓塞（VTE）的风险，循证指南可帮助医生评估患者发生静脉血栓栓塞的风险，并推荐预防方案。根据第六届美国胸科医师学会（ACCP）指南，评估了高危住院患者适当的血栓预防使用率。方法：采用2002年1月~ 2005年9月Premier Perspective （TM）住院患者数据库中的出院信息。纳入的患者年龄≥40岁，住院时间≥6天，无抗凝禁忌。通过比较每日血栓预防使用情况（包括血栓预防类型、抗凝剂剂量和血栓预防持续时间）与ACCP建议，在7组急性医疗条件下确定静脉血栓栓塞预防的适宜性。结果：227家医院共196104例出院患者符合纳入标准。静脉血栓形成的总体预防率为61.8%，尽管适当的血栓预防率仅为33.9%。在66.1%未接受适当血栓预防的出院患者中，38.4%未接受预防，4.7%仅接受机械预防，6.3%剂量不适当，16.7%根据ACCP建议接受不适当的预防时间。结论：本研究强调了美国急症医院适当的血栓预防率较低，三分之二的出院患者没有按照第6期ACCP指南接受预防。需要更多的努力来改善使用适当的血栓预防按照ACCP的建议。
Background: As hospitalized medical patients may be at risk of venous thromboembolism (VTE), evidence-based guidelines are available to help physicians assess patients' risk for VTE, and to recommend prophylaxis options. The rate of appropriate thromboprophylaxis use in at-risk medical inpatients was assessed in accordance with the 6th American College of Chest Physicians (ACCP) guidelines. Methods: Hospital discharge information from the Premier Perspective (TM) inpatient data base from January 2002 to September 2005 was used. Included patients were 40 years old or more, with a length of hospital stay of 6 days or more, and had no contraindications for anticoagulation. The appropriateness of VTE thromboprophylaxis was determined in seven groups with acute medical conditions by comparing the daily thromboprophylaxis usage, including type of thromboprophylaxis, dosage of anticoagulant and duration of thromboprophylaxis, with the ACCP recommendations. Results: A total of 196 104 discharges from 227 hospitals met the inclusion criteria. The overall VTE thromboprophylaxis rate was 61.8%, although the appropriate thromboprophylaxis rate was only 33.9%. Of the 66.1% discharged patients who did not receive appropriate thromboprophylaxis, 38.4% received no prophylaxis, 4.7% received mechanical prophylaxis only, 6.3% received an inappropriate dosage, and 16.7% received an inappropriate prophylaxis duration based on ACCP recommendations. Conclusions: This study highlights the low rates of appropriate thromboprophylaxis in US acute-care hospitals, with two-thirds of discharged patients not receiving prophylaxis in accordance with the 6th ACCP guidelines. More effort is required to improve the use of appropriate thromboprophylaxis in accordance with the ACCP recommendations.