住院病人静脉血栓栓塞药物预防的相关因素：住院医患血栓与止血（MITH）研究》。

IF 5.5 2区医学 Q1 HEMATOLOGY

Journal of Thrombosis and Haemostasis Pub Date : 2024-12-01 DOI:10.1016/j.jtha.2024.08.016

Allen B. Repp , Andrew D. Sparks , Katherine Wilkinson , Nicholas S. Roetker , Jordan K. Schaefer , Ang Li , Leslie A. McClure , Deirdra R. Terrell , Augusto Ferraris , Alys Adamski , Nicholas L. Smith , Neil A. Zakai

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引用次数: 0

摘要

背景尽管指南建议对医院获得性静脉血栓栓塞症（HA-VTE）进行风险评估，以便为预防决策提供依据，但研究表明，住院内科病人药物预防使用不当。目标确定在医疗服务机构住院的成人中启动 HA-VTE 药物预防的相关因素.设计使用 2016 年至 2019 年期间在四个学术医疗中心医疗服务机构住院的成人患者的电子健康记录数据进行队列研究.参与者在 111,550 例未接受中剂量或全剂量抗凝治疗的入院患者中，有 48,520 例（43.主要测量HA-VTE药物预防启动的候选预测因素，包括已知的HA-VTE风险因素、预测的HA-VTE风险和入院时存在的出血诊断。主要结果经年龄、性别、种族/民族和研究地点调整后，HA-VTE药物预防启动的最强临床预测因素是营养不良和慢性阻塞性肺病。血小板减少症和胃肠道出血史与启动 HA-VTE 药物预防的几率降低有关。预测 HA-VTE 风险最高的两个三分位数的患者接受 HA-VTE 药物预防的几率低于最低（第一）三分位数的患者（第二三分位数的 OR 为 0.84，95% CI [0.81，0.86]；第三三分位数的 OR 为 0.95，95% CI [0.92，0.98]）。结论在尚未接受抗凝药物治疗的患者中，预测HA-VTE风险较高和有出血风险因素的患者在住院头两天开始接受HA-VTE药物预防治疗的比例较低。无法评估预测风险较高的患者未开始药物预防的原因。

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Factors associated with venous thromboembolism pharmacoprophylaxis initiation in hospitalized medical patients: the Medical Inpatients Thrombosis and Hemostasis study

Background

Although guidelines recommend risk assessment for hospital-acquired venous thromboembolism (HA-VTE) to inform prophylaxis decisions, studies demonstrate inappropriate utilization of pharmacoprophylaxis in hospitalized medical patients. Predictors of pharmacoprophylaxis initiation in medical inpatients remain largely unknown.

Objectives

To determine factors associated with HA-VTE pharmacoprophylaxis initiation in adults hospitalized on medical services.

Methods

We performed a cohort study using electronic health record data from adult patients hospitalized on medical services at 4 academic medical centers between 2016 and 2019. Main measures were candidate predictors of HA-VTE pharmacoprophylaxis initiation, including known HA-VTE risk factors, predicted HA-VTE risk, and bleeding diagnoses present on admission.

Results

Among 111 550 admissions not on intermediate or full-dose anticoagulation, 48 520 (43.5%) received HA-VTE pharmacoprophylaxis on the day of or the day after admission. After adjustment for age, sex, race/ethnicity, and study site, the strongest clinical predictors of HA-VTE pharmacoprophylaxis initiation were malnutrition and chronic obstructive pulmonary disease. Thrombocytopenia and history of gastrointestinal bleeding were associated with decreased odds of HA-VTE pharmacoprophylaxis initiation. Patients in the highest 2 tertiles of predicted HA-VTE risk were less likely to receive HA-VTE pharmacoprophylaxis than patients in the lowest (first) tertile (OR, 0.84; 95% CI, 0.81-0.86 for the second tertile; OR, 0.95; 95% CI, 0.92-0.98 for the third tertile).

Conclusion

Among patients not already receiving anticoagulants, HA-VTE pharmacoprophylaxis initiation during the first 2 hospital days was lower in patients with a higher predicted HA-VTE risk and those with risk factors for bleeding. Reasons for not initiating pharmacoprophylaxis in those with a higher predicted HA-VTE risk could not be assessed.

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来源期刊

Journal of Thrombosis and Haemostasis 医学-外周血管病

CiteScore

24.30

自引率

3.80%

发文量

321

审稿时长

1 months

期刊介绍： The Journal of Thrombosis and Haemostasis (JTH) serves as the official journal of the International Society on Thrombosis and Haemostasis. It is dedicated to advancing science related to thrombosis, bleeding disorders, and vascular biology through the dissemination and exchange of information and ideas within the global research community. Types of Publications: The journal publishes a variety of content, including: Original research reports State-of-the-art reviews Brief reports Case reports Invited commentaries on publications in the Journal Forum articles Correspondence Announcements Scope of Contributions: Editors invite contributions from both fundamental and clinical domains. These include: Basic manuscripts on blood coagulation and fibrinolysis Studies on proteins and reactions related to thrombosis and haemostasis Research on blood platelets and their interactions with other biological systems, such as the vessel wall, blood cells, and invading organisms Clinical manuscripts covering various topics including venous thrombosis, arterial disease, hemophilia, bleeding disorders, and platelet diseases Clinical manuscripts may encompass etiology, diagnostics, prognosis, prevention, and treatment strategies.