Antithrombotic therapy practices in US hospitals in an era of practice guidelines
Antithrombotic therapy practices in US hospitals in an era of practice guidelines
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DOI：
10.1001/archinte.165.13.1458
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发表时间：
2005-07-11
影响因子：
--
通讯作者：
Shillington, AC
中科院分区：
文献类型：
--
作者：
Tapson, VF;Hyers, TM;Shillington, AC
背景资料：抗血栓治疗是有效的预防血栓栓塞性疾病，但它需要仔细的风险-效益assessment.Methods：抗血栓治疗数据进行了回顾性收集，从住院病历在38家美国医院。随机选择2000年7月1日至2003年6月30日期间接受房颤、急性心肌梗死、深静脉血栓形成或肺栓塞治疗的患者和接受全膝关节置换术、全髋关节置换术或髋关节骨折手术预防的患者。患者平均年龄为66.1岁。在卒中高危房颤患者中，只有54.7%的患者接受华法林钠治疗，20.6%的患者既未接受阿司匹林也未接受华法林治疗。在急性心肌梗死患者中，只有75.5%的患者在到达医院时服用阿司匹林。在骨科手术后，只有85.6%的患者接受了静脉抗凝剂或华法林的预防治疗。在49.4%的深静脉血栓形成、肺栓塞或两者兼有的患者中，在连续2天达到2.0或更高的国际标准化比值之前停止使用普通肝素或低分子量肝素。深静脉血栓形成或肺栓塞患者很少出院时接受桥接治疗（一种可注射抗凝剂加华法林），尽管住院时间明显短于出院时单独服用华法林（4.0 vs 8.1天; P
Background: Antithrombotic therapy is efficacious for the prevention of thromboembolic disease, but it necessitates careful risk-benefit assessment.Methods: Antithrombotic therapy data were retrospectively collected from inpatient medical records at 38 US hospitals. Patients treated for atrial fibrillation, acute myocardial infarction, deep vein thrombosis, or pulmonary embolism and patients given prophylaxis for total knee replacement, total hip replacement, or hip fracture surgery between July 1, 2000, and June 30, 2003, were randomly selected.Results: The medical records of 3778 patients (53.3% men) were included. The mean patient age was 66.1 years. Of patients with atrial fibrillation at high risk for stroke, only 54.7% received warfarin sodium, and 20.6% received neither aspirin nor warfarin. Of patients with acute myocardial infarction, only 75.5% received aspirin on hospital arrival. After orthopedic surgery procedures, only 85.6% of patients received prophylaxis with a parenteral anticoagulant agent or warfarin. In 49.4% of patients with deep vein thrombosis, pulmonary embolism, or both, unfractionated or low-molecular-weight heparin use was discontinued before an international normalized ratio of 2.0 or greater was achieved for 2 consecutive days. Patients with deep vein thrombosis or pulmonary embolism were rarely discharged from the hospital with bridge therapy (an injectable anticoagulant agent plus warfarin), although the length of hospitalization was significantly shorter than if discharged taking warfarin alone (4.0 vs 8.1 days; P