Venous thromboembolism prophylaxis in acutely ill hospitalized medical patients. A retrospective multicenter study

Nieto, José Antonio; Camara, Timoteo; Camacho, Isabel Llano; Investigators, Meditrom

doi:10.1016/j.ejim.2014.07.005

Cited by 15 publications

(8 citation statements)

References 27 publications

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“…Elderly patients have a higher number of concomitant diseases, thus, differences in the mean age of included patients beside the definition of the high VTE risk in the different studies, may explain these results. Anyway, other recent studies including Italian and European populations (15,16) found similar risk profiles reinforcing the external validity of our results. Moreover, although the use of antithrombotic prophylaxis in patients at high risk of VTE according to the PPS seems to be associated with a reduced risk of VTE (9,17), no high quality RCT has evaluated the risk/benefit profile of this treatment.…”

Section: Agesupporting

confidence: 91%

Combined assessment of thrombotic and haemorrhagic risk in acute medical patients

Regina¹,

Orlandini²,

Marchini³

et al. 2016

Thromb Haemost

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Acute medical patients have a high risk of venous thromboembolic events (VTE). Unfortunately, the fear of bleeding complications limits the use of antithrombotic prophylaxis in this setting. To stratify the VTE and haemorrhagic risk, two clinical scores (PADUA, IMPROVE) have recently been developed. However, it is not clear how many patients have a concomitant high VTE and haemorrhagic risk and what is the use of prophylaxis in this situation. To clarify these issues we performed a prospective cohort study enrolling consecutive patients admitted to internal medicine. Patients admitted to internal medicine (January to December 2013) were included. VTE and haemorrhagic risk were evaluated in all the included patients. Use and type of anti-thrombotic prophylaxis was recorded. A total of 1761 patients (mean age 77.6 years) were enrolled; 76.8% (95% CI 74.7-78.7) were at high VTE risk and 11.9% (95% CI 10.4-13.5) were at high haemorrhagic risk. Anti-thrombotic prophylaxis was used in 80.5% of patients at high VTE risk and in 6.5% at low VTE risk (p<0.001), and in 16.6% at high haemorrhagic risk and in 72.5% at low haemorrhagic risk (p<0.001). Prophylaxis was used in 20.4% at both high VTE and haemorrhagic risk and in 88.9% at high VTE risk but low haemorrhagic risk. At multivariate-analysis, use of prophylaxis appeared highly influenced by the VTE risk (OR 68.2, 95% CI 43.1 - 108.0). In conclusion, many patients admitted to internal medicine were at high risk of VTE. Since almost 90% of them were at low haemorrhagic risk, pharmacological prophylaxis may be safely prescribed in most of these patients.

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Section: Agesupporting

confidence: 91%

Combined assessment of thrombotic and haemorrhagic risk in acute medical patients

Regina¹,

Orlandini²,

Marchini³

et al. 2016

Thromb Haemost

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“…Another relevant difference of our study is that it is exclusively confined to medical patients, as well as the extremely high age and degree of comorbidity of our cohort, compared with larger series in which patients with a mean age more than 10 years younger and very low rates of multiple comorbidity were included. 19 20 …”

Section: Discussionmentioning

confidence: 99%

Compliance with current VTE prophylaxis guidelines and risk factors linked to complications of VTE prophylaxis in medical inpatients: a prospective cohort study in a Spanish internal medicine department

Novo-Veleiro

Alvela-Suárez²,

Costa-Grille

et al. 2018

BMJ Open

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ObjectivesTo evaluate the degree of compliance with the current guidelines regarding venous thromboembolism (VTE) prophylaxis in medical patients during admission and to identify risk factors linked to complications of VTE prophylaxis.DesignProspective cohort study.SettingThe Internal Medicine Department of the University Hospital of Santiago de Compostela (tertiary referral hospital).ParticipantsA total of 396 hospitalised, elderly patients who did not undergo surgery and had no active or previous oral anticoagulation or low molecular weight heparin (LMWH) treatment (during the previous year) and who received VTE prophylaxis during admission.Primary and secondary outcome measuresThe degree of compliance with the current guidelines was estimated by calculating PADOVA and IMPROVE indexes in all cases. We analysed the development of the following complications: major and minor bleeding, major and minor haematoma and decrease of platelet count.ResultsWe found that VTE prophylaxis was correctly indicated in 88.4% of patients. We found two (0.5%) cases with major bleeding, 17 (4.3%) with minor bleeding, 30 (7.6%) with decreased platelet count, 29 (7.3%) with major haematoma and 82 (20.7%) with minor haematoma. After multivariate logistic regression analysis, the presence of major haematomas was linked to obesity (OR 4.1; 95% CI 1.8 to 9.2, p=0.001), concomitant antiplatelet treatment (OR 2.7; 95% CI 1.1 to 6.5, p=0.03) and enoxaparin use (OR 3.5; 95% CI 1.1 to 10.9, p=0.029), and the presence of minor haematomas was associated with PADOVA index <4 points (OR 3.1; 95% CI 1.5 to 6.4, p=0.003) and diabetes mellitus (OR 2; 95% CI 1.1 to 3.7, p=0.031).ConclusionsComplications during VTE prophylaxis in elderly hospitalised medical patients are frequent even with correct application of current guidelines. The main factors linked to haematomas were obesity and concomitant antiplatelet treatment, the presence of which should lead physicians to exercise extreme caution. The use of tinzaparin for VTE prophylaxis in these patients could have a better safety profile.

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“…According to a systematic review[ 9 ], limited evidence suggests that the use of compressive and pneumatic devices does not yield significantly different results compared with no treatment. Research by Lilly et al[ 10 ] also indicated that the mortality risk of those receiving mechanical device prophylaxis was not lower than that of patients without VTE prophylaxis and that patients managed with prophylactic anticoagulation therapy had a significantly lower risk of death than those receiving only mechanical device prophylaxis. A study comparing IPC and GCS[ 11 ] showed that the use of IPC was associated with a significantly lower VTE incidence compared with no mechanical thromboprophylaxis but that GCS use was not associated with a decreased VTE incidence.…”

Section: Discussionmentioning

confidence: 99%

A Survey of the Knowledge of Venous Thromboembolism Prophylaxis among the Medical Staff of Intensive Care Units in North China

et al. 2015

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BackgroundGuideline concordance for venous thromboembolism (VTE) prophylaxis in critically ill patients in intensive care units (ICUs) varies across different countries.ObjectiveTo explore how the medical staff of ICUs in China comprehend and practice VTE prophylaxis.MethodQuestionnaires comprising 39 questions and including 4 dimensions of thromboprophylaxis were administered in ICUs in North China.ResultsIn all, 52 ICUs at 23 tertiary hospitals in 7 Chinese provinces and municipalities were surveyed. A total of 2500 questionnaires were sent, and 1861 were returned, corresponding to a response rate of approximately 74.4%. Of all surveyed medical staff, 36.5% of physicians and 22.2% of nurses were aware of the guidelines in China, and 19.0% of physicians and 9.5% of nurses comprehended the 9th edition of the guidelines of the American College of Chest Physicians (ACCP). Additionally, 37.6% of the medical staff chose a prophylaxis method based on the related guidelines, and 10.3% could demonstrate the exact indication for mechanical pattern application. Worries about skin injury, difficulty with removal and discomfort during mechanical thromboprophylaxis were cited by more than 30% of nurses, which was significantly more frequent than for physicians (graduated compression stockings: 54.3% VS 34.1%, 60.7% VS 49%, and 59.4% VS 54%, p = 0.000; intermittent pneumatic compression: 31% VS 22.2%, 19.2% VS 13.9%, and 37.8% VS 27.2%, p = 0.000).Conclusions and RelevanceThe knowledge of VTE prophylaxis among the medical staff of ICUs in North China remains limited, which may lead to a lack of standardization of VTE prophylaxis. Strengthened, standardized training may help medical staff to improve their comprehension of the relevant guidelines and may finally reduce the occurrence of VTE in ICUs and improve the prognosis of critically ill patients with VTE.

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Venous thromboembolism prophylaxis in acutely ill hospitalized medical patients. A retrospective multicenter study

Cited by 15 publications

References 27 publications

Combined assessment of thrombotic and haemorrhagic risk in acute medical patients

Combined assessment of thrombotic and haemorrhagic risk in acute medical patients

Compliance with current VTE prophylaxis guidelines and risk factors linked to complications of VTE prophylaxis in medical inpatients: a prospective cohort study in a Spanish internal medicine department

A Survey of the Knowledge of Venous Thromboembolism Prophylaxis among the Medical Staff of Intensive Care Units in North China

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