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Jin ZY, Li CM, Qu H, Yang WT, Wen JH, Ren HL. Validation of a pulmonary embolism risk assessment model in gynecological inpatients : Clinical trial: A single-center, retrospective study. Thromb J 2024; 22:47. [PMID: 38840142 PMCID: PMC11151723 DOI: 10.1186/s12959-024-00616-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 05/21/2024] [Indexed: 06/07/2024] Open
Abstract
OBJECTIVE To compare the predictive efficacy of the PADUA and Caprini models for pulmonary embolism (PE) in gynecological inpatients, analyze the risk factors for PE, and validate whether both models can effectively predict mortality rates. METHODS A total of 355 gynecological inpatients who underwent computed tomography pulmonary angiography (CTPA) were included in the retrospective analysis. The comparative assessment of the predictive capabilities for PE between the PADUA and Caprini was carried out using receiver operating characteristic (ROC) curves. Logistic regression analysis was used to identify risk factors associated with PE. Additionally, Kaplan-Meier survival analysis plots were generated to validate the predictive efficacy for mortality rates. RESULTS Among 355 patients, the PADUA and Caprini demonstrated the area under the curve (AUC) values of 0.757 and 0.756, respectively. There was no statistically significant difference in the AUC between the two models (P = 0.9542). Multivariate logistic analysis revealed immobility (P < 0.001), history of venous thromboembolism (VTE) (P = 0.002), thrombophilia (P < 0.001), hormonal treatment (P = 0.022), and obesity (P = 0.019) as independent risk factors for PE. Kaplan-Meier survival analysis demonstrated the reliable predictive efficacy of both the Caprini (P = 0.00051) and PADUA (P = 0.00031) for mortality. ROC for the three- and six-month follow-ups suggested that the Caprini model exhibited superior predictive efficacy for mortality. CONCLUSIONS The PADUA model can serve as a simple and effective tool for stratifying high-risk gynecological inpatients before undergoing CTPA. The Caprini model demonstrated superior predictive efficacy for mortality rates.
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Affiliation(s)
- Zhen-Yi Jin
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, No.8 Gongti South Road, Beijing, 100020, China
| | - Chun-Min Li
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, No.8 Gongti South Road, Beijing, 100020, China
| | - Hong Qu
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, No.8 Gongti South Road, Beijing, 100020, China
| | - Wen-Tao Yang
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, No.8 Gongti South Road, Beijing, 100020, China
| | - Jia-Hao Wen
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, No.8 Gongti South Road, Beijing, 100020, China
| | - Hua-Liang Ren
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, No.8 Gongti South Road, Beijing, 100020, China.
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Baugh CW, Cash RE, Meguerdichian D, Dunham L, Stump T, Stevens R, Reust A, White B, Dutta S. An Electronic Medical Record Intervention to Increase Pharmacologic Prophylaxis for Venous Thromboembolism in Emergency Department Observation Patients. Ann Emerg Med 2024; 83:24-34. [PMID: 37725025 DOI: 10.1016/j.annemergmed.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 08/10/2023] [Accepted: 08/14/2023] [Indexed: 09/21/2023]
Abstract
STUDY OBJECTIVE The role of venous thromboembolism (VTE) prophylaxis among patients receiving emergency department (ED) observation unit care is unclear. We investigated an electronic health record-based clinical decision support tool aimed at increasing pharmacologic VTE prophylaxis use among at-risk patients placed in ED observation units. METHODS We conducted an interrupted time-series study of an Epic-based best practice advisory implemented in May 2019 at a health care system comprising 2 academic medical centers and 4 community hospitals with dedicated ED observation units. The best practice advisory alerted staff at 24 hours to conduct a risk assessment and linked to a VTE prophylaxis order set. We used an interrupted time series, Bayesian structured time series, and a multivariable mixed-effect regression model to estimate the intervention effect. RESULTS Prior to the best practice advisory implementation, there were 8,895 ED observation unit patients with a length of stay more than or equal to 24 hours, and 0.9% received pharmacologic VTE prophylaxis. Afterward, there were 12,664 ED observation unit patients with a length of stay more than or equal to 24 hours, and 4.8% received pharmacologic VTE prophylaxis. The interrupted time series and causal impact analysis showed a statistically significant increase in VTE prophylaxis (eg, absolute percent difference 3.8%, 95% confidence interval 3.5 to 4.1). In a multivariable model, only the intervention was significantly associated with receiving VTE prophylaxis (odds ratio 4.56, 95% confidence interval 2.22 to 9.37). CONCLUSION An electronic health record-based alert helped to prompt staff caring for ED observation unit patients at risk for VTE with prolonged visits to order recommended pharmacologic prophylaxis. The best risk assessment model to use and the true incidence of VTE events in this population are unclear.
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Affiliation(s)
| | - Rebecca E Cash
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | | | - Lisette Dunham
- Clinical Informatics, Mass General Brigham Digital, Boston, MA
| | - Timothy Stump
- Clinical Informatics, Mass General Brigham Digital, Boston, MA
| | - Ronelle Stevens
- Mosaic Inpatient Applications, Boston Children's Hospital, Boston, MA
| | - Audrey Reust
- Department of Emergency Medicine, Brigham & Women's Hospital, Boston, MA
| | - Benjamin White
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Sayon Dutta
- Clinical Informatics, Mass General Brigham Digital, Boston, MA; Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
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Xiong W, Cheng Y, Zhao Y. Risk Scores in Venous Thromboembolism Guidelines of ESC, ACCP, and ASH: An Updated Review. Clin Appl Thromb Hemost 2024; 30:10760296241263856. [PMID: 38887044 PMCID: PMC11185021 DOI: 10.1177/10760296241263856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/24/2024] [Accepted: 06/07/2024] [Indexed: 06/20/2024] Open
Abstract
Venous thromboembolism (VTE) is associated with high morbidity and mortality. Risk scores associated with VTE have been widely used in clinical practice. Among numerous scores published, those included in guidelines are usually typical risk scores which have been extensively validated and globally recognized. This review provides an updated overview of the risk scores associated with VTE endorsed by 3 guidelines which are highly recognized in the field of VTE including the European Society of Cardiology, American College of Chest Physicians, and American Society of Hematology, focusing on the development, modification, validation, and comparison of these scores, to provide a comprehensive and updated understanding of all the classic risk scores associated with VTE to medical readers including but not limited to cardiologists, pulmonologists, hematologists, intensivists, physicians, surgeons, and researchers. Although each score recommended by these guidelines was more or less validated, there may still be room for further improvement. It may still be necessary to seek simpler, more practical, and more universally applicable VTE-related risk scores in the future.
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Affiliation(s)
- Wei Xiong
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Pulmonary and Critical Care Medicine, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yi Cheng
- Department of Pulmonary and Critical Care Medicine, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yunfeng Zhao
- Department of Pulmonary and Critical Care Medicine, Punan Hospital, Pudong New District, Shanghai, China
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Bortsova MA, Demchenko EA, Fedotov PA, Ganenko OS, Osipova MA, Korneva LO, Musaeva BB, Sazonova YV, Simonenko MA, Sitnikova MY. Tolerability of an Individualized Physical Rehabilitation Program in Patients Dependent on Inotropic Support With End-Stage Chronic Heart Failure. KARDIOLOGIIA 2023; 63:36-45. [PMID: 38088111 DOI: 10.18087/cardio.2023.11.n2528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/31/2023] [Indexed: 12/18/2023]
Abstract
Aim To assess the tolerability of an individualized physical rehabilitation program (PRP) in inotrope-dependent patients with end-stage chronic heart failure (CHF).Material and methods This prospective randomized study included 120 men aged 18-65 years with left ventricular ejection fraction ≤30 % and blood pressure ≥90 / 60 mm Hg. Patients who have received dobutamine or dopamine for ≥2 weeks were randomized into two groups: group 1, 40 patients who participated in the PRP and group 2, 40 patients who did not participate in the PRP. Group 3 included 40 patients without inotropic support who participated in the PRP.Results Patients of groups 1 and 3 attended >80 % of the scheduled classes without developing life-threatening adverse events (AEs) associated with exercise (E). After 6 months of the study, the exercising patients achieved a comparable (average) E intensity: 44 [35; 50]% and 45 [40;52]% of heart rate reserve and Borg scale scores 14 [12; 14] and 13 [11; 14] in groups 1 and 3, respectively (p>0.05). Initially, after 3 and 6 months at the peak of physical activity in groups 1 and 3, there was no decrease in arterial blood oxygen saturation according to pulse oximetry (SpO2) <93 %. At baseline, lactate levels in central venous blood at rest were normal in all groups. After 6 months, the lactate concentration was 1.1 mmol / l in group 1, 2.3 mmol / l in group 2, and 1.4 mmol / l in group 3 (р1-2=0.005; p2-3=0.008, respectively). At the E peak at baseline, after 3 and 6 months, comparable increases in lactate not exceeding 3 mmol / l were detected in groups 1 and 3.Conclusion The study allowed assessment of the tolerability of individualized PRP performed at the aerobic level of energy supply, in inotropic-dependent patients with CHF. Individualized 6-month PRP in inotropic-dependent patients with end-stage CHF, provided safety criteria are met, is well tolerated and does not increase the number of AEs associated with CHF and physical rehabilitation (PR). Continued inotropic support with dopamine or dobutamine should not be considered as a contraindication to PR in patients with CHF in the absence of E intolerance or life-threatening AEs.
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Affiliation(s)
- M A Bortsova
- Almazov National Medical Research Center, St-Petersburg
| | - E A Demchenko
- Almazov National Medical Research Center, St-Petersburg
| | - P A Fedotov
- Almazov National Medical Research Center, St-Petersburg
| | - O S Ganenko
- Almazov National Medical Research Center, St-Petersburg
| | - M A Osipova
- Almazov National Medical Research Center, St-Petersburg
| | - L O Korneva
- Almazov National Medical Research Center, St-Petersburg
| | - B B Musaeva
- Almazov National Medical Research Center, St-Petersburg
| | - Yu V Sazonova
- Almazov National Medical Research Center, St-Petersburg
| | - M A Simonenko
- Almazov National Medical Research Center, St-Petersburg
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Michalski W, Poniatowska G, Jońska‐Gmyrek J, Żółciak‐Siwińska A, Zastawna I, Lemiński A, Macios A, Jakubczyk M, Demkow T, Wiechno P. Simple yet (more?) effective. Venous thromboembolism risk assessment model for germ cell tumour patients receiving first-line chemotherapy. Cancer Med 2023; 12:18542-18556. [PMID: 37584231 PMCID: PMC10557845 DOI: 10.1002/cam4.6458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/12/2023] [Accepted: 08/03/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Germ cell tumours (GCT) are highly curable malignancies. Venous thromboembolism (VTE) is a serious complication, needing better risk assessment models (RAM). AIM Identification of VTE incidence and risk factors in metastatic GCT patients starting first-line chemotherapy. Developing a RAM and comparing it to Khorana risk score (KRS) and Padua Prediction Score (PPS). MATERIAL AND METHODS We retrospectively analysed GCT patients staged IS-IIIC. VTE risk factors were identified with logistic regression. Area under curve of receiver operating characteristic (AUC-ROC), Akaike and Bayesian Information Criteria (AIC, BIC) were calculated for the developed RAM, KRS and PPS. RESULTS Among 495 eligible patients, VTE occurred in 69 (13.9%), including 40 prior to chemotherapy. Vein compression (OR: 8.96; 95% CI: 2.85-28.13; p < 0.001), clinical stage IIIB-IIIC (OR: 5.68; 95% CI: 1.82-17.70; p = 0.003) and haemoglobin concentration (OR for 1 g/dL decrease: 1.32; 95% CI: 1.03-1.67; p = 0.026) were significant in our RAM. KRS ≥ 3 (OR: 3.31; 95% CI: 1.77-6.20; p < 0.001), PPS 4-5 (OR: 3.06; 95% CI: 1.49-6.29; p = 0.002) and PPS > 5 (OR 8.05; 95% CI 3.79-17.13; p < 0.001) correlated with VTE risk. Diagnostic criteria (AUC-ROC, AIC, BIC) for the developed RAM, KRS and PPS were (0.885; 0.567; -1641), (0.588; 0.839; -1576) and (0.700; 0.799; -1585), respectively. In the numerical score, the optimal cut-off point for high-risk was ≥9, with sensitivity, specificity, positive and negative predictive value of 0.78, 0.77, 0.35 and 0.96, respectively. CONCLUSIONS Our RAM, based on vein compression, clinical stage and haemoglobin concentration proved superior to both KRS and PPS. VTE is frequent in GCT patients.
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Affiliation(s)
- Wojciech Michalski
- Department of Urological CancerMaria Sklodowska‐Curie National Research Institute of OncologyWarsawPoland
| | - Grażyna Poniatowska
- Department of Urological CancerMaria Sklodowska‐Curie National Research Institute of OncologyWarsawPoland
| | - Joanna Jońska‐Gmyrek
- Department of Gynaecological OncologyMaria Sklodowska‐Curie National Research Institute of OncologyWarsawPoland
| | - Agnieszka Żółciak‐Siwińska
- Department of Gynaecological OncologyMaria Sklodowska‐Curie National Research Institute of OncologyWarsawPoland
| | - Inga Zastawna
- Clinical Centre of Cardiology and Rare Diseases of the Cardiovascular SystemNational Institute of Medicine of the Ministry of the Interior and AdministrationWarsawPoland
| | - Artur Lemiński
- Department of Urology and Urological OncologyPomeranian Medical UniversitySzczecinPoland
| | - Anna Macios
- Department of Cancer PreventionMaria Sklodowska‐Curie National Research Institute of OncologyWarsawPoland
| | - Michał Jakubczyk
- SGH Warsaw School of Economics, Institute of Econometrics, Collegium of Economic AnalysisWarsawPoland
| | - Tomasz Demkow
- Department of Urological CancerMaria Sklodowska‐Curie National Research Institute of OncologyWarsawPoland
| | - Paweł Wiechno
- Department of Urological CancerMaria Sklodowska‐Curie National Research Institute of OncologyWarsawPoland
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彭 清, 刘 佳, 刘 焱, 尚 华, 唐 果, 韩 雅, 龙 丽. [Application of Padua prediction score and serum albumin level in evaluating venous thromboembolism in rheumatic inpatients]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2023; 55:625-630. [PMID: 37534642 PMCID: PMC10398766 DOI: 10.19723/j.issn.1671-167x.2023.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Indexed: 02/03/2024]
Abstract
OBJECTIVE To investigate the status of venous thromboembolism (VTE) in rheumatic inpatients, and to explore the efficiency of Padua prediction score (PPS) in the patient population. In addition, to analyze the relationship between serum albumin and VTE in rheumatic inpatients. METHODS Data of inpatients with rheumatology were retrospectively collected and analyzed at Sichuan Provincial People's Hospital from September 2018 to September 2019. Occurrence of VTE was compared between high (PPS≥4) and low (PPS < 4) risk groups. PPS were analyzed in the VTE and non-VTE patients. Multivariate Logistic regression model was used to analyze the risk factors in PPS and the relationship between serum albumin and VTE. RESULTS A total of 1 547 patients were included in this study, and 27 (1.7%) had symptomatic VTE. Among the symptomatic VTE cases, 19 (1.2%) had deep vein thrombosis (DVT) only, 6 (0.4%) had pulmonary thromboembolism (PTE) only, and 2 (0.1%) were diagnosed with DVT and PTE. PPS in the VTE and non-VTE groups were 3.33±1.78 and 1.80±0.97 respectively (P < 0.05).The number of patients with PPS≥4 in the VTE group and non-VTE group was 37.0% and 4.3% respectively (P < 0.01). The average serum albumin level in the VTE group was lower than that in non-VTE group [(29.79±6.36) g/L vs. (35.17±6.31) g/L, P < 0.001]. Seventy-six cases was divided into high-risk group of VTE, while 1 471 cases were in the low-risk group, and the incidence of VTE was 13.2% and 1.2% respectively (P < 0.001). Logistic regression analysis showed that ongoing hormonal treatment, age≥70 years, trauma and/or surgery ≤30 d, reduced mobility and previous VTE were risk factors of VTE in the rheumatology patients, OR values were 7.11, 7.07, 3.40, 2.40 and 2.00, respectively. Lower serum albumin level was the risk factor of VTE in the rheumatology patients [OR=0.88 (95%CI: 0.82-0.94)]. CONCLUSION The incidence of VTE was relatively higher in the hospitalized patients in Department of Rheumatology and Immunology. Glucocorticoid therapy was the highest risk factor of VTE and lower serum albumin level also was the risk factor. Although the PPS can reflect the risk of VTE in rheumatic inpatients to some extent, its effectiveness is limited. PPS can be optimized for quantitative VTE risk assessment of rheumatic inpatients in the future.
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Affiliation(s)
- 清 彭
- 成都市第二人民医院风湿免疫科, 成都 610000Department of Rheumatology and Immunology, Chengdu Second People's Hospital, Chengdu 610000, China
- 遵义医科大学第一临床学院, 贵州遵义 563000Zunyi Medical University, Zunyi 563000, Guizhou, China
| | - 佳君 刘
- 遵义医科大学第一临床学院, 贵州遵义 563000Zunyi Medical University, Zunyi 563000, Guizhou, China
| | - 焱 刘
- 遵义医科大学第一临床学院, 贵州遵义 563000Zunyi Medical University, Zunyi 563000, Guizhou, China
| | - 华 尚
- 遵义医科大学第一临床学院, 贵州遵义 563000Zunyi Medical University, Zunyi 563000, Guizhou, China
| | - 果 唐
- 重庆市璧山区人民医院风湿免疫科, 重庆 402760Department of Rheumatology and Immunology, The Bishan Hospital of Chongqing, Chongqing 402760, China
| | - 雅欣 韩
- 成都市温江区人民医院风湿免疫科, 成都 610000Department of Rheumatology and Immunology, The Wenjiang Hospital of Chengdu, Chengdu 610000, China
| | - 丽 龙
- 遵义医科大学第一临床学院, 贵州遵义 563000Zunyi Medical University, Zunyi 563000, Guizhou, China
- 四川省人民医院风湿免疫科, 成都 610000Department of Rheumatology and Immunology, Sichuan Provincial People's Hospital, Chengdu 610000, China
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Anand V, Ramakrishnan D, Jha RK, Shankaran R, Mishra A, Dwivedi SK. Comparison of Caprini’s and Padua’s Risk Assessment Scores in the Prediction of Deep Vein Thrombosis in Surgical Patients at a Tertiary Care Hospital. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03405-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Forgo G, Micieli E, Ageno W, Castellucci LA, Cesarman‐Maus G, Ddungu H, De Paula EV, Dumantepe M, Guillermo Esposito MC, Konstantinides SV, Kucher N, McLintock C, Ní Áinle F, Spyropoulos AC, Urano T, Hunt BJ, Barco S. An update on the global use of risk assessment models and thromboprophylaxis in hospitalized patients with medical illnesses from the World Thrombosis Day steering committee: Systematic review and meta-analysis. J Thromb Haemost 2022; 20:409-421. [PMID: 34822215 PMCID: PMC9299991 DOI: 10.1111/jth.15607] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 11/18/2021] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Venous thromboembolism (VTE) is a leading cause of cardiovascular morbidity and mortality. The majority of VTE events are hospital-associated. In 2008, the Epidemiologic International Day for the Evaluation of Patients at Risk for Venous Thromboembolism in the Acute Hospital Care Setting (ENDORSE) multinational cross-sectional study reported that only approximately 40% of medical patients at risk of VTE received adequate thromboprophylaxis. METHODS In our systematic review and meta-analysis, we aimed at providing updated figures concerning the use of thromboprophylaxis globally. We focused on: (a) the frequency of patients with an indication to thromboprophylaxis according with individual models; (b) the use of adequate thromboprophylaxis; and (c) reported contraindications to thromboprophylaxis. Observational nonrandomized studies or surveys focusing on medically ill patients were considered eligible. RESULTS After screening, we included 27 studies from 20 countries for a total of 137 288 patients. Overall, 50.5% (95% confidence interval [CI]: 41.9-59.1, I2 99%) of patients had an indication to thromboprophylaxis: of these, 54.5% (95% CI: 46.2-62.6, I2 99%) received adequate thromboprophylaxis. The use of adequate thromboprophylaxis was 66.8% in Europe (95% CI: 50.7-81.1, I2 98%), 44.9% in Africa (95% CI: 31.8-58.4, I2 96%), 37.6% in Asia (95% CI: 25.7-50.3, I2 97%), 58.3% in South America (95% CI: 31.1-83.1, I2 99%), and 68.6% in North America (95% CI: 64.9-72.6, I2 96%). No major differences in adequate thromboprophylaxis use were found across risk assessment models. Bleeding, thrombocytopenia, and renal/hepatic failure were the most frequently reported contraindications to thromboprophylaxis. CONCLUSIONS The use of anticoagulants for VTE prevention has been proven effective and safe, but thromboprophylaxis prescriptions are still unsatisfactory among hospitalized medically ill patients around the globe with marked geographical differences.
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Affiliation(s)
- Gabor Forgo
- Department of AngiologyUniversity Hospital ZurichZurichSwitzerland
| | - Evy Micieli
- Department of AngiologyUniversity Hospital ZurichZurichSwitzerland
| | - Walter Ageno
- Department of Clinical MedicineUniversity of InsubriaVareseItaly
| | - Lana A. Castellucci
- Department of MedicineOttawa Hospital Research InstituteUniversity of OttawaOttawaONCanada
| | | | | | | | - Mert Dumantepe
- Department of Cardiovascular SurgeryUskudar University School of MedicineIstanbulTurkey
| | | | | | - Nils Kucher
- Department of AngiologyUniversity Hospital ZurichZurichSwitzerland
| | - Claire McLintock
- National Women's Health Auckland City Hospital Auckland New ZealandAucklandNew Zealand
| | - Fionnuala Ní Áinle
- Department of HaematologyMater Misericordiae University Hospital and Rotunda HospitalDublinIreland
- School of MedicineUniversity College DublinDublinIreland
| | - Alex C. Spyropoulos
- Institute for Health Innovations and Outcomes ResearchFeinstein Institutes for Medical Research and the Zucker School of Medicine at Hofstra/NorthwellNew YorkNew YorkUSA
- Department of Medicine, Anticoagulation and Clinical Thrombosis ServicesNorthwell Health at Lenox Hill HospitalNew YorkNew YorkUSA
| | - Tetsumei Urano
- Shizuoka Graduate University of Public HealthShizuokaJapan
| | - Beverley J. Hunt
- Thrombosis & Haemophilia CentreGuys & St Thomas’ NHS Foundation TrustLondonUK
| | - Stefano Barco
- Department of AngiologyUniversity Hospital ZurichZurichSwitzerland
- Center for Thrombosis and HemostasisUniversity Medical Center MainzMainzGermany
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9
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Skeik N, Smith JE, Patel L, Mirza AK, Manunga JM, Beddow D. Risk and Management of Venous Thromboembolism in Patients with COVID-19. Ann Vasc Surg 2021; 73:78-85. [PMID: 33333197 PMCID: PMC7834325 DOI: 10.1016/j.avsg.2020.11.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 11/14/2020] [Indexed: 12/15/2022]
Abstract
Background One of the most pronounced and poorly understood pathological features of COVID-19 infection has been high risk for venous and arterial thromboembolic complications. An increasing number of thromboembolic events are being reported almost on a daily basis, and the medical community has struggled to predict and mitigate this risk. We aimed to review available literature on the risk and management of COVID-19 related venous thromboembolism (VTE), and provide evidence-based guidance to manage these events. Methods A literature review of VTE complications in patients with COVID-19 was performed, in addition to a summary of the societal guidelines and present pathways implemented at our institution for the management of both in- and outpatient COVID-19 related VTE. Results Although a significant VTE risk has been confirmed in patients with COVID-19, literature addressing best ways to mitigate this risk is lacking. Furthermore, there has been very limited guidance provided by societal guidelines to help prevent and manage VTE associated with the COVID-19 infection. In light of the available data, we advise that all patients admitted with suspected or confirmed COVID-19 receive pharmacological prophylaxis if bleeding risk is acceptable. For patients with COVID-19 who have been discharged from the emergency department or hospital, we suggest extended thromboprophylaxis (up to 39 days) as long as bleeding risk is low. Conclusions We believe that this literature summary along with our center recommendations and algorithms provide valuable guidance to providers caring for patients with COVID-19 related VTE. More research is needed to standardize prophylaxis and management protocols for these patients.
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Affiliation(s)
- Nedaa Skeik
- Vascular Medicine, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN Vascular Medicine, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN.
| | - Jenna E Smith
- Minneapolis Heart Institute Foundation, Research Department, Minneapolis, MN
| | - Love Patel
- Department of Internal Medicine, Abbott Northwestern Hospital, Allina Health, Minneapolis, MN
| | - Aleem K Mirza
- Section of Vascular and Endovascular Surgery, Vascular Medicine, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN
| | - Jesse M Manunga
- Section of Vascular and Endovascular Surgery, Vascular Medicine, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN
| | - David Beddow
- Department of Internal Medicine, Mercy Hospital, Allina Health, Coon Rapids, MN
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Nemani A, von zur Mühlen C, Steffen F, Schulte J, Bode C, Krohn-Grimberghe M. Do Inpatients Receive Risk-Based Prophylactic Treatment for Thrombotic Events? Clin Appl Thromb Hemost 2021; 27:1076029621995563. [PMID: 33872084 PMCID: PMC8058795 DOI: 10.1177/1076029621995563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Current guidelines recommend risk-based use of prophylaxis for preventing medical inpatients from venous thromboembolism (VTE). Little is known about the current prescription practice, and even less whether differences between subspecialists like cardiologists, usually treating patients with thrombotic or thromboembolic diseases, and gastroenterologists, treating more patients with gastrointestinal bleeding complications, exist. METHODS We performed a retrospective chart review of patients on cardiology and gastroenterology wards of our university hospital. Patients with a clear indication for anticoagulation and contraindication against antithrombotic treatment were excluded. A total of 450 patients per specialty were included. Quantitative risk assessment models were used to determine the risk of a VTE (Padua Prediction Score (PPS), IMPROVE Score) and bleeding (IMPROVE-Bleeding and HAS-BLED Score). RESULTS The overall rate of VTE prophylaxis was high in both patient populations. Significant more low-risk cardiology compared to gastroenterology patients received drug-based prophylaxis. Furthermore, crucial discrepancies were found in the way individual patients would be classified based on PPS and IMPROVE Score. Finally, not the risk category but the length of hospital stay was best at predicting which patient received prophylaxis.
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Affiliation(s)
- Armin Nemani
- University Heart Center Freiburg – Bad Krozingen, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Germany
| | - Constantin von zur Mühlen
- University Heart Center Freiburg – Bad Krozingen, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Germany
| | - Friederike Steffen
- University Heart Center Freiburg – Bad Krozingen, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Germany
| | - Johannes Schulte
- University Heart Center Freiburg – Bad Krozingen, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Germany
| | - Christoph Bode
- University Heart Center Freiburg – Bad Krozingen, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Germany
| | - Marvin Krohn-Grimberghe
- University Heart Center Freiburg – Bad Krozingen, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Germany
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11
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Zeng DX, Xu JL, Mao QX, Liu R, Zhang WY, Qian HY, Xu L. Association of Padua prediction score with in-hospital prognosis in COVID-19 patients. QJM 2020; 113:789-793. [PMID: 32652021 PMCID: PMC7454846 DOI: 10.1093/qjmed/hcaa224] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 06/07/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Nearly 20% novel coronavirus disease 2019 (COVID-19) patients have abnormal coagulation function. Padua prediction score (PPS) is a validated tools for venous thromboembolism (VTE) risk assessment. However, its clinical value in COVID-19 patients' evaluation was unclear. METHODS We prospectively evaluated the VTE risk of COVID-19 patients using PPS. Demographic and clinical data were collected. Association of PPS with 28-day mortality was analyzed by multivariate logistic regression and Kaplan-Meier analysis. RESULTS Two hundred and seventy-four continuous patients were enrolled, with total mortality of 17.2%. Patients in high PPS group, with significantly abnormal coagulation, have a higher levels of interleukin 6 (25.27 vs. 2.55 pg/ml, P < 0.001), prophylactic anticoagulation rate (60.7% vs. 6.5%, P < 0.001) and mortality (40.5% vs. 5.9%, P < 0.001) when compared with that in low PPS group. Critical patients showed higher PPS (6 vs. 2 score, P < 0.001) than that in severe patients. Multivariate logistic regression revealed the independent risk factors of in-hospital mortality included high PPS [odds ratio (OR): 7.35, 95% confidence interval (CI): 3.08-16.01], increased interleukin-6 (OR: 11.79, 95% CI: 5.45-26.20) and elevated d-dimer (OR: 4.65, 95% CI: 1.15-12.15). Kaplan-Meier analysis indicated patients with higher PPS had a significant survival disadvantage. Prophylactic anticoagulation in higher PPS patients shows a mild advantage of mortality but without statistical significance (37.1% vs. 45.7%, P = 0.42). CONCLUSION Higher PPS associated with in-hospital poor prognosis in COVID-19 patients. Prophylactic anticoagulation showed a mild advantage of mortality in COVID-19 patients with higher PPS, but it remain to need further investigation.
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Affiliation(s)
- Da-xiong Zeng
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Soochow University
| | - Jia-li Xu
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Soochow University
| | - Qiu-xia Mao
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Soochow University
| | - Rui Liu
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Soochow University
| | - Wei-yun Zhang
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Soochow University
| | - Hong-ying Qian
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Soochow University
- Corresponding author: Mrs. Lan Xu, Department of Nursing, the First Affiliated Hospital of Soochow University. No. 899, Pinghai Road, Suzhou, China, 215006. E-mail: . Mrs. Hong-ying Qian, the Department of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Soochow University, No. 899, Pinghai Road, Suzhou, P. R. China, 215006. E-mail:
| | - Lan Xu
- Department of Nursing, the First Affiliated Hospital of Soochow University
- Corresponding author: Mrs. Lan Xu, Department of Nursing, the First Affiliated Hospital of Soochow University. No. 899, Pinghai Road, Suzhou, China, 215006. E-mail: . Mrs. Hong-ying Qian, the Department of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Soochow University, No. 899, Pinghai Road, Suzhou, P. R. China, 215006. E-mail:
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12
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Ebied AM, Jessee J, Chen Y, Konopack J, Radhakrishnan N, DeRemer CE. Factors Influencing Prescribers' Decision for Extending Venous Thromboembolism Prophylaxis in the Medical Patient Population following Hospitalization. TH OPEN 2020; 4:e218-e219. [PMID: 32935074 PMCID: PMC7486138 DOI: 10.1055/s-0040-1716720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 08/11/2020] [Indexed: 11/06/2022] Open
Abstract
Introduction
Venous thromboembolism (VTE) prophylaxis during hospitalization has clearly defined metrics for risk stratification and practice policy employed to ensure processes of adherence. However, acceptance for practice or even the level and timeline of risk is less clear during the immediate time after hospitalization. With emerging new oral anticoagulant agents, data are available that may influence prescribing in the outpatient setting following hospitalization. A survey was created to determine the level of acceptance or influences for practice surrounding continuation of anticoagulation following hospitalization.
Methods
This study was designed as a single-center survey of hospitalist and family medicine physician to assess influences to the physician's impression for risk of VTE prophylaxis and knowledge of therapy options.
Results
Physicians reported depending heavily on medical center protocols for determining anticoagulation at hospital discharge. Prescribing postdischarge anticoagulation was reported to be affected by lack of comfort with prescribing oral medications and concerns with risk of bleeding for all types of anticoagulation outweighing the perceived benefit. Additionally, the decision whether to prescribe these medications at discharge was reported to be related to perceived cost and other patient barriers such as concerns over route of administration.
Conclusion
Concerns for bleeding were an influence and likely resulted in shorter duration for VTE prophylaxis being prescribed posthospitalization.
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Affiliation(s)
- Alex M Ebied
- Department of Clinical Sciences, High Point University Fred Wilson School of Pharmacy, High Point, North Carolina, United States
| | - Jeremiah Jessee
- Department of Pharmacy, Novant Health Forsyth Medical Center, Winston-Salem, North Carolina, United States
| | - Yiqing Chen
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, Florida, United States
| | - Jason Konopack
- Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville, Florida, United States
| | - Nila Radhakrishnan
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, United States
| | - Christina E DeRemer
- Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, Florida, United States
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13
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Kandagatla P, Goranta S, Antoine H, Marashi SM, Schmoekel N, Gupta AH. PADUA score as a predictor for pulmonary embolism: a potential strategy for reducing unnecessary imaging. J Thromb Thrombolysis 2019; 47:566-571. [DOI: 10.1007/s11239-018-01801-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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14
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Riesgo de trombosis venosa profunda en el paciente domiciliario con enfermedad aguda. ¿Valoramos correctamente el riesgo desde Atención Primaria? Comparativa de 2 casos. Semergen 2018; 44:e123-e124. [DOI: 10.1016/j.semerg.2018.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 04/16/2018] [Accepted: 05/05/2018] [Indexed: 11/20/2022]
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15
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Tazi Mezalek Z, Nejjari C, Essadouni L, Samkaoui M, Serraj K, Ammouri W, Kanjaa N, Belkhadir Z, Housni B, Awab M, Faroudy M, Bono W, Kabbaj S, Akkaoui M, Barakat M, Rifai R, Charaf H, Aziz A, Elachhab Y, Azzouzi A. Evaluation and management of thromboprophylaxis in Moroccan hospitals at national level: the Avail-MoNa study. J Thromb Thrombolysis 2018; 46:113-119. [PMID: 29651665 DOI: 10.1007/s11239-018-1657-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Venous thromboembolism (VTE) is a common clinical problem that is associated with substantial morbidity and mortality. The aim of this study was to describe the clinical practices in VTE prophylaxis in university and peripheral hospitals in Morocco. This is a national, cross-sectional, multicenter, observational study assessing the management of the VTE risk in selected Moroccan hospitals (four university and three peripheral). The thromboembolic risk of the selected patients was assessed according to the American College of Chest Physicians (ACCP) guidelines (2008). We hypothesized that interventions for VTE guideline implementation in those hospitals may improve prophylaxis use for hospitalized patients. A total of 1318 patients were analyzed: 467 (35.5%) medical and 851 (64.5%) surgical. The mean age of patients was 52.6 ± 16.5 years, and 52.7% were female. A total of 51.1% patients were considered to be at risk of VTE according to ACCP guidelines and were eligible for thromboprophylaxis (TP). Medical patients were more likely to present risk factors than surgical patients (53.6 vs. 50.7%, respectively). TP was prescribed for 53.1% of these patients, 57.4% in at-risk surgical patients and 50.3% in at-risk medical patients. TP was also prescribed for 42.9% of non-at-risk patients. The concordance between the recommended and the prescribed prophylaxis was poor for the total population (kappa = 0.110). TP did not improve sufficiently in our hospitals, even after implementation of the guidelines. New strategies are required to appropriately address TP in hospitalized patients.
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Affiliation(s)
- Z Tazi Mezalek
- Department of Internal Medicine/Hematology, Ibn Sina University Hospital, Rabat, Morocco. .,Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco.
| | - C Nejjari
- Laboratory of Epidemiology, Clinical Research and Community Health Faculty of Medicine and Pharmacy, Fez, Morocco
| | - L Essadouni
- Internal Medicine Department, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital, Cadi Ayyad University, Marrakech, Morocco
| | - M Samkaoui
- Department of Anesthesia, Emergency and Intensive Care Medicine, Faculty of Medicine and Pharmacy, Mohammed VI Hospital, Cadi Ayyad University, Marrakech, Morocco
| | - K Serraj
- Internal Medicine Department, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital, University Mohammed VI, Oujda, Morocco
| | - W Ammouri
- Department of Internal Medicine/Hematology, Ibn Sina University Hospital, Rabat, Morocco.,Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - N Kanjaa
- Department of Anesthesia Reanimation, Faculty of Medicine and Pharmacy, Hassan II University Hospital, Fez, Morocco
| | - Z Belkhadir
- Pole of Anesthesia and Intensive Care, Palliative Care Unit, National Institute of Oncology, Rabat, Morocco
| | - B Housni
- Anesthesia Reanimation Department, Mohammed VI University Hospital, Oujda, Morocco
| | - M Awab
- Anesthesia Reanimation Department, Ibn Sina University Hospital, Rabat, Morocco
| | - M Faroudy
- Anesthesia Reanimation- Trauma Unit, Ibn Sina University Hospital, Rabat, Morocco
| | - W Bono
- Internal Medicine Department, Hassan II University Hospital, Fez, Morocco
| | - S Kabbaj
- Anesthesia Reanimation Department, Specialty Hospital, Rabat, Morocco
| | - M Akkaoui
- Anesthesia Reanimation, Mohammed V Hospital, Meknes, Morocco
| | - M Barakat
- Anesthesia Reanimation, Mohammed V Hospital, Tangier, Morocco
| | - R Rifai
- Traumatology Orthopedics, Mohammed V Hospital, Meknes, Morocco
| | - H Charaf
- Anesthesia Reanimation, Mohammed V Hospital, Casablanca, Morocco
| | - A Aziz
- Traumatology Orthopedics, Mohammed V Hospital, Casablanca, Morocco
| | - Y Elachhab
- Laboratory of Epidemiology, Clinical Research and Community Health Faculty of Medicine and Pharmacy, Fez, Morocco
| | - A Azzouzi
- Anesthesia Reanimation Department, Ibn Sina University Hospital, Rabat, Morocco
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16
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Chaudhary R, Damluji A, Batukbhai B, Sanchez M, Feng E, Chandra Serharan M, Moscucci M. Venous Thromboembolism Prophylaxis: Inadequate and Overprophylaxis When Comparing Perceived Versus Calculated Risk. Mayo Clin Proc Innov Qual Outcomes 2017; 1:242-247. [PMID: 30225423 PMCID: PMC6132201 DOI: 10.1016/j.mayocpiqo.2017.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Guidelines for venous thromboembolism (VTE) prophylaxis recommend appropriate risk stratification using risk estimation models as high risk or low risk followed by initiation of chemical or mechanical prophylaxis, respectively. We explored adherence to guidelines on the basis of the documentation of VTE prophylaxis. A retrospective medical record review of 437 consecutive adult patients (≥18 years) admitted to general medical wards under medicine service between January 1, 2015, and March 1, 2015, was performed. The primary outcome was appropriateness of risk stratification using the Padua Prediction Score. Secondary outcomes were appropriateness of type of prophylaxis (chemical vs mechanical) and cost-benefit analysis. We observed appropriate stratification based on the documented risk (compared with the calculated risk) in 54.9% of the patients (40.8% with low risk vs 72.1% with high risk; P<.001). Overall, 182 of 240 low-risk patients received unnecessary chemical prophylaxis, whereas 23 of 197 high-risk patients without contraindications for chemical prophylaxis received mechanical or no prophylaxis. No clinical VTE events were noted in the patients inappropriately assigned to mechanical or no prophylaxis. Also, 67.3% of patients with both low documented and low calculated risk and 74.5% of patients with low documented and high calculated risk received chemical prophylaxis, consistent with a tendency toward overtreatment. A total of 4068 annualized patient-days ($77,652/y) of inappropriate chemical prophylaxis were administered. In conclusion, estimation of the risk of VTE based on clinical impression was not congruent with the risk calculated using risk prediction models and was associated with a tendency toward overtreatment. These data support the inclusion of VTE risk calculators in electronic health record systems.
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Affiliation(s)
- Rahul Chaudhary
- Sinai Hospital of Baltimore, LifeBridge Health Cardiovascular Institute, Baltimore, MD
| | - Abdulla Damluji
- Sinai Hospital of Baltimore, LifeBridge Health Cardiovascular Institute, Baltimore, MD.,Division of Cardiology, Johns Hopkins University, Baltimore, MD
| | - Bhavina Batukbhai
- Sinai Hospital of Baltimore, LifeBridge Health Cardiovascular Institute, Baltimore, MD
| | - Martin Sanchez
- Sinai Hospital of Baltimore, LifeBridge Health Cardiovascular Institute, Baltimore, MD
| | - Eric Feng
- Sinai Hospital of Baltimore, LifeBridge Health Cardiovascular Institute, Baltimore, MD
| | | | - Mauro Moscucci
- Sinai Hospital of Baltimore, LifeBridge Health Cardiovascular Institute, Baltimore, MD.,University of Michigan Health System, Ann Arbor, MI
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17
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Ye F, Bell LN, Mazza J, Lee A, Yale SH. Variation in Definitions of Immobility in Pharmacological Thromboprophylaxis Clinical Trials in Medical Inpatients: A Systematic Review. Clin Appl Thromb Hemost 2016; 24:13-21. [PMID: 28301904 DOI: 10.1177/1076029616677802] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Although immobility is a common risk factor for venous thromboembolism (VTE) in medical inpatients, lack of a consistent definition of this term may limit accurate assessment of VTE risk for thromboprophylaxis. OBJECTIVE To examine various definitions of immobility used in recent pharmacological thromboprophylaxis clinical trials. DATA SOURCES PubMed and relevant references from articles/reviews from 2008 to 2016 were searched. Randomized controlled trials (RCTs) and other clinical studies involving adult hospitalized medical patients in acute care hospital settings that used the term immobility were selected. Two investigators independently abstracted data in duplicate, and accuracy was checked by a third investigator. RESULTS Twenty-one clinical studies were included. There was heterogeneity among individual VTE risk factors, with respect to the definition of immobility in medical inpatients in these trials. Thirteen studies utilized objective criteria to define "immobility" including duration (12 studies) and distance or time walked (6 studies). In contrast, 7 studies focused principally on subjective definitions (ie, describing the nature of immobility rather than specifying its quantitative measurement). Three RCTs vaguely defined the level of patient's immobility after hospitalization. CONCLUSION Despite the well-known effectiveness of pharmacological thromboprophylaxis for the prevention of VTE in acutely ill medical patients, there is no current consensus on how to define immobility. The heterogeneous nature of definitions of immobility has led to uncertainty about the importance of immobility in VTE risk assessment models. Although clinical studies have incorporated varying definitions of immobility into their inclusion criteria, immobility as a specific VTE risk factor has not been clearly defined.
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Affiliation(s)
- Fan Ye
- 1 North Florida Regional Medical Center, UCF COM/HCA GME Consortium Internal Medicine, Gainesville, FL, USA
| | - Lauren N Bell
- 1 North Florida Regional Medical Center, UCF COM/HCA GME Consortium Internal Medicine, Gainesville, FL, USA
| | - Joseph Mazza
- 2 Marshfield Clinic Research Foundation, Marshfield, WI, USA
| | - Arthur Lee
- 3 North Florida Regional Medical Center, The Cardiac and Vascular Institute, Gainesville, FL, USA
| | - Steven H Yale
- 1 North Florida Regional Medical Center, UCF COM/HCA GME Consortium Internal Medicine, Gainesville, FL, USA
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