Thromboprophylaxis patterns, risk factors, and outcomes of care in the medically ill patient population
Thromboprophylaxis patterns, risk factors, and outcomes of care in the medically ill patient population
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DOI：
10.1016/j.thromres.2013.08.013
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发表时间：
2013-11-01
影响因子：
7.5
通讯作者：
Spyropoulos, Alex C.
中科院分区：
文献类型：
--
作者：
Mahan, Charles E.;Fisher, Maxine D.;Spyropoulos, Alex C.
简介：患有内科疾病的住院患者出院后发生静脉血栓栓塞 (VTE) 的风险增加。本研究旨在检查血栓预防模式、危险因素和出院后结果。方法：这是一项回顾性索赔分析，涉及从医院图表样本中提取的行政索赔数据和住院数据。 2005 年至 2009 年间，年龄≥ 40 岁、因非手术原因住院≥ 2 天的患者均纳入其中。医院图表数据是针对出院后 30 天没有使用抗凝剂证据的随机患者样本提取的。综合数据确定了住院血栓预防（抗凝或机械预防）是否可以降低出院后 90 天发生 VTE 的风险。使用 Cox 比例风险模型和逻辑回归计算风险比 (HR) 和比值比 (OR)。 结果：在索赔分析中的 141,628 名患者中，3.9% 接受了抗凝药物（3.6% 为华法林）。 VTE、再住院和死亡率分别为 1.9%、17.2% 和 6.2%。出院后 VTE 的最强预测因素是 VTE 病史（HR = 4.0，95% 置信区间 [CI]：3.3-4.8）和再住院（HR = 3.9，95% CI：3.6-4.3）。在 504 份病历中，209 份 (41.5%) 报告了住院血栓预防。接受和未接受住院血栓预防的患者出院后 VTE 发生率没有统计学差异。未使用 VTE 预防的患者的全因死亡率更高。结论：院内和出院后 VTE 预防的使用率较低。在出院后缺乏抗凝治疗的情况下，院内 VTE 预防并不能降低出院后 VTE 的风险。住院期间和出院后联合进行血栓预防可降低出院后短期全因死亡率的几率。 (c) 2013 Elsevier Ltd. 保留所有权利。
Introduction: Medically ill, hospitalized patients are at increased risk for venous thromboembolism (VTE) after discharge. This study aimed to examine thromboprophylaxis patterns, risk factors, and post-discharge outcomes.Methods: This was a retrospective claims analysis involving administrative claims data and in-patient data abstracted from a sample of hospital charts. Patients aged >= 40 years hospitalized for >= 2 days for nonsurgical reasons between 2005 and 2009 were included. Hospital chart data were abstracted for a random sample of patients without evidence of anticoagulant use at 30 days post-discharge. The combined data determined whether in-patient thromboprophylaxis (anticoagulant or mechanical prophylaxis) reduces risk of VTE at 90 days post-discharge. Hazard ratios (HR) and odds ratios (OR) were calculated using Cox proportional hazard models and logistic regression.Results: Of 141,628 patients in the claims analysis, 3.9% received anticoagulants (3.6% warfarin). VTE, rehospitalization, and mortality rates were 1.9%, 17.2%, and 6.2%, respectively. The strongest predictors of post-discharge VTE were history of VTE (HR = 4.0, 95% confidence interval [CI]: 3.3-4.8), and rehospitalization (HR = 3.9, 95% CI: 3.6-4.3). Of 504 medical charts, 209 (41.5%) reported in-patient thromboprophylaxis. There was no statistically significant difference in post-discharge VTE rates between patients who did and did not receive in-patient thromboprophylaxis. All-cause mortality was greater among patients without use of VTE prophylaxis.Conclusion: Utilization rates of in-hospital and post-discharge VTE prophylaxis were low. In-hospital VTE prophylaxis did not reduce the risk of post-discharge VTE in the absence of post-discharge anticoagulation. Combined in-patient and post-discharge thromboprophylaxis lowered the odds of short-term, all-cause post-discharge mortality. (c) 2013 Elsevier Ltd. All rights reserved.