Venous thromboembolism prophylaxis in acutely ill hospitalized medical patients - Findings from the International medical prevention registry on venous thromboembolism
Venous thromboembolism prophylaxis in acutely ill hospitalized medical patients - Findings from the International medical prevention registry on venous thromboembolism
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DOI：
10.1378/chest.06-2993
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发表时间：
2007-09-01
期刊：
影响因子：
9.6
通讯作者：
Anderson, Frederick A.
中科院分区：
文献类型：
--
作者：
Tapson, Victor F.;Decousus, Herve;Anderson, Frederick A.
背景：循证指南建议有静脉血栓栓塞症(VTE)风险的危重住院内科患者应接受预防。我们的目的是描述在国际静脉血栓栓塞症医学预防登记处登记的急症住院内科患者中预防静脉血栓栓塞症的临床实践。参与的医院每月招收连续10名符合条件的危重患者。病人的管理是由治疗医生决定的。结果：从2002年7月至2006年9月30日，来自12个国家的52家医院的15,156名患者入选，其中50%接受了院内药理学和/或机械性VTE预防。在美国和其他参与国家，根据美国胸科医师学会(ACCP)的指南建议，分别有52%和43%的患者应该接受预防措施。只有大约60%的患者符合ACCP要求预防的标准，或者有资格参加随机临床试验，这些试验表明了药物预防的好处，实际上只有60%的患者接受了预防。做法差异很大。间歇性气动加压在美国是最常见的医学预防形式，尽管在其他国家很少使用(分别为22%和0.2%)。普通肝素是美国使用最多的药理学方法(21%的患者)，低分子肝素在其他参与国家使用最多(40%)。在美国和其他参与的国家中，弹性袜的使用也不尽相同(分别为3%和7%)。结论：我们的数据表明，医生为住院的急性疾病患者提供VTE预防的做法并不理想，并强调了在医院改进现有证据偏向指南的实施的必要性。
Background: Evidence-based guidelines recommend that acutely ill hospitalized medical patients who are at risk of venous thromboembolism (VTE) should receive prophylaxis. Our aim was to characterize the clinical practices for VTE prophylaxis in acutely ill hospitalized medical patients enrolled in the international Medical Prevention Registry on Venous Thromboembolism (IMPROVE).Methods: IMPROVE is an ongoing, multinational, observational study. Participating hospitals enroll the first 10 consecutive eligible acutely ill medical patients each month. Patient management is determined by the treating physicians. An analysis of data on VTE prophylaxis practices is presented.Results: From July 2002 to September 30, 2006, 15,156 patients were enrolled from 52 hospitals in 12 countries, of whom 50% received in-hospital pharmacologic and/or mechanical VTE prophylaxis. In the United States and other participating countries, 52% and 43% of patients, respectively, should have received prophylaxis according to guideline recommendations from the American College of Chest Physicians (ACCP). Only approximately 60% of patients who either met the ACCP criteria for requiring prophylaxis or were eligible for enrollment in randomized clinical trials that have shown the benefits of pharmacologic prophylaxis actually received prophylaxis. Practices varied considerably. Intermittent pneumatic compression was the most common form of medical prophylaxis utilized in the United States, although it was used very rarely in other countries (22% vs 0.2%, respectively). Unfractionated heparin was the most frequent pharmacologic approach used in the United States (21% of patients), with low-molecular-weight heparin used most frequently in other participating countries (40%). There was also variable use of elastic stockings in the United States and other participating countries (3% vs 7%, respectively).Conclusions: Our data suggest that physicians' practices for providing VTE prophylaxis to acutely ill hospitalized medical patients are suboptimal and highlight the need for improved implementation of existing evidence-biased guidelines in hospitals.