Underuse of medical thromboprophylaxis in mobile elderly inpatients: The SWITCO65+ cohort.
anticoagulants
hospitalization
inpatients
quality improvement
risk assessment
thrombosis
venous thromboembolism
Journal
Research and practice in thrombosis and haemostasis
ISSN: 2475-0379
Titre abrégé: Res Pract Thromb Haemost
Pays: United States
ID NLM: 101703775
Informations de publication
Date de publication:
Jan 2021
Jan 2021
Historique:
received:
31
12
2019
revised:
09
04
2020
accepted:
16
04
2020
entrez:
4
2
2021
pubmed:
5
2
2021
medline:
5
2
2021
Statut:
epublish
Résumé
Hospital-associated venous thromboembolism (HA-VTE) can be prevented by pharmacologic thromboprophylaxis. Thrombotic risk assessment models (RAMs) are essential tools to improve inadequately prescribed thromboprophylaxis. Among cases of HA-VTE, our study objectives are to explore the classifications of available thrombosis RAMs, the adequacy of thromboprophylaxis and risk factors for inadequate thromboprophylaxis. We identified cases of HA-VTE occurring during medical hospitalizations within a multicenter Swiss venous thromboembolism (VTE) cohort (2009-2013). We calculated the proportion of VTE cases deemed at high risk with 4 VTE RAMs (Geneva, Simplified Geneva, Padua, and Improve) and the adequacy of administered pharmacologic thromboprophylaxis, and explored risk factors for underprescription of thromboprophylaxis in high-risk inpatients. Among 66 medical inpatients with HA-VTE, 60.6% had pulmonary embolism. The sensitivities of the Geneva, Simplified Geneva, Padua, and Improve RAMs were 86.4%, 80.3%, 72.7%, and 57.6%, respectively. The proportion of inadequate thromboprophylaxis was high, as 62.5%-71.1% of high-risk inpatients had not received it. Among the high-risk group according to the Simplified Geneva RAM, absence of immobilization was the only variable significantly associated with an inadequate use of thromboprophylaxis (odds ratio, 3.59; 95% confidence interval, 1.08-11.88). We found a dramatically high proportion of inadequate medical thromboprophylaxis among inpatients who suffered from HA-VTE. This reinforces the need for global and local quality-improvement efforts to promote adequate use of thromboprophylaxis in elderly inpatients. Mobility may favor the underuse of thromboprophylaxis, and clinicians should stay alert to other thrombotic risk factors in mobile inpatients.
Sections du résumé
BACKGROUND
BACKGROUND
Hospital-associated venous thromboembolism (HA-VTE) can be prevented by pharmacologic thromboprophylaxis. Thrombotic risk assessment models (RAMs) are essential tools to improve inadequately prescribed thromboprophylaxis. Among cases of HA-VTE, our study objectives are to explore the classifications of available thrombosis RAMs, the adequacy of thromboprophylaxis and risk factors for inadequate thromboprophylaxis.
METHODS
METHODS
We identified cases of HA-VTE occurring during medical hospitalizations within a multicenter Swiss venous thromboembolism (VTE) cohort (2009-2013). We calculated the proportion of VTE cases deemed at high risk with 4 VTE RAMs (Geneva, Simplified Geneva, Padua, and Improve) and the adequacy of administered pharmacologic thromboprophylaxis, and explored risk factors for underprescription of thromboprophylaxis in high-risk inpatients.
RESULTS
RESULTS
Among 66 medical inpatients with HA-VTE, 60.6% had pulmonary embolism. The sensitivities of the Geneva, Simplified Geneva, Padua, and Improve RAMs were 86.4%, 80.3%, 72.7%, and 57.6%, respectively. The proportion of inadequate thromboprophylaxis was high, as 62.5%-71.1% of high-risk inpatients had not received it. Among the high-risk group according to the Simplified Geneva RAM, absence of immobilization was the only variable significantly associated with an inadequate use of thromboprophylaxis (odds ratio, 3.59; 95% confidence interval, 1.08-11.88).
CONCLUSIONS
CONCLUSIONS
We found a dramatically high proportion of inadequate medical thromboprophylaxis among inpatients who suffered from HA-VTE. This reinforces the need for global and local quality-improvement efforts to promote adequate use of thromboprophylaxis in elderly inpatients. Mobility may favor the underuse of thromboprophylaxis, and clinicians should stay alert to other thrombotic risk factors in mobile inpatients.
Identifiants
pubmed: 33537538
doi: 10.1002/rth2.12361
pii: S2475-0379(22)01293-6
pmc: PMC7845057
doi:
Types de publication
Journal Article
Langues
eng
Pagination
142-147Informations de copyright
© 2020 The Authors. Research and Practice in Thrombosis and Haemostasis published by Wiley Periodicals, Inc on behalf of International Society on Thrombosis and Haemostasis.
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