Padua prediction score or clinical judgment for decision making on antithrombotic prophylaxis: a quasi-randomized controlled trial
Padua prediction score or clinical judgment for decision making on antithrombotic prophylaxis: a quasi-randomized controlled trial
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DOI：
10.1007/s11239-016-1358-z
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发表时间：
2016-10-01
影响因子：
4
通讯作者：
Becattini, Cecilia
中科院分区：
文献类型：
--
作者：
Germini, Federico;Agnelli, Giancarlo;Becattini, Cecilia
帕多瓦预测评分（PPS）已被建议为最佳的可用模型的风险评估静脉血栓栓塞症（VTE）住院医疗患者。其在临床实践中使用的影响从未进行过前瞻性评价。根据准随机研究设计，将入住内科第1节的连续患者分配至基于PPS的决策策略，建议PPS评分aeyen 4的患者进行血栓预防，将入住第2节的患者分配至基于临床判断的策略。研究患者在出院时接受下肢完全压迫超声检查。主要结局为住院期间的症状性或无症状性VTE。次要结局为VTE（不包括孤立的远端深静脉血栓形成）、眼睑炎和适当的血栓预防。628例患者纳入分析，PPS组235例，临床判断组393例。两组患者的住院时间、近期创伤或手术的患病率以及中风的发生率不同。与对照组相比，PPS组的VTE发生率显著较低（8.5 vs. 15.5%，OR 0.51，95% CI 0.30-0.86），调整血栓预防使用和患者PPS风险类别后也是如此（OR 0.54，95% CI 0.31-0.94）。总之，PPS的使用与较高的适当血栓预防处方率相关;在其他次要结局中未发现显著差异。与临床判断相比，使用PPS评估VTE风险与VTE发生率降低相关。这些结果需要在未来的研究中得到证实。
The Padua prediction score (PPS) has been suggested as the best available model for the assessment of the risk of venous thromboembolism (VTE) in hospitalized medical patients. The impact of its use in clinical practice has never been prospectively evaluated. According to a quasi-randomized study design, consecutive patients admitted to Internal Medicine Section 1 were allocated to a PPS-based decisional strategy suggesting thromboprophylaxis in patients with PPS score aeyen4, and those admitted to Section 2 to a clinical judgment-based strategy. Study patients underwent complete compression ultrasonography of the lower limbs at discharge. The primary outcome was symptomatic or asymptomatic VTE during hospital stay. Secondary outcomes were VTE excluding isolated distal deep vein thrombosis, bleedings, and appropriate thromboprophylaxis. 628 patients were included in the analysis, 235 in the PPS group, and 393 in the clinical judgment group. The two groups differed for length of hospital stay, prevalence of recent trauma or surgery, and stroke. Compared with control, the PPS group had a significantly lower incidence of VTE (8.5 vs. 15.5 %, OR 0.51, 95 % CI 0.30-0.86), also after adjusting for thromboprophylaxis use and patient PPS-risk category (OR 0.54, 95 % CI 0.31-0.94). In conclusion, the use of PPS was associated with a higher rate of appropriate thromboprophylaxis prescription; no significant differences were found in the other secondary outcomes. The use of PPS for the assessment of risk for VTE is associated with a reduced incidence of VTE compared with the clinical judgment. These result needs to be confirmed in future studies.