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Geng S, Li Y, Ge J, Guo X, Liu Y, Jiang H. Reliability of Risk Assessment for Intra-Hospital Venous Thromboembolism: An Exploratory Cross-Sectional Study. J Multidiscip Healthc 2023; 16:1541-1547. [PMID: 37283949 PMCID: PMC10241171 DOI: 10.2147/jmdh.s414480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 05/25/2023] [Indexed: 06/08/2023] Open
Abstract
Objective Hospital-associated venous thromboembolism (VTE) is a major cause of unintended death in hospitalized patients. Standardized and reasonable prevention measures may reduce its occurrence effectively. This study aims to analyze the consistency of VTE risk assessment by physicians and nurses and its potential causes. Methods A total of 897 patients admitted to Shanghai East Hospital from December 2021 to March 2022 were recruited. The VTE assessment scores of physicians and nurses and the activities of daily living (ADL) scores within the first 24 h of admission were collected for each patient. Cohen's Kappa values were calculated to assess the inter-rater consistency of these scores. Results VTE scores were fairly consistent between doctors and nurses in both surgical (Kappa = 0.30, 95% CI: 0.25-0.34) and non-surgical (Kappa = 0.35, 95% CI: 0.31-0.38) departments. There was moderate agreement in VTE risk assessment between doctors and nurses in surgical departments (Kappa = 0.50, 95% CI: 0.38-0.62) while fair agreement in VTE risk assessment between doctors and nurses in non-surgical departments (Kappa = 0.32, 95% CI: 0.26-0.40). The assessment of the mobility impairment component was fairly consistent between doctors and nurses in the non-surgical departments (Kappa = 0.31, 95% CI: 0.25-0.37). Conclusion Due to the poor consistency of VTE risk assessment between doctors and nurses, it is necessary to provide systematic training and develop a standardized assessment process for healthcare professionals to construct a scientific and effective VTE prevention and treatment system.
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Affiliation(s)
- Shasha Geng
- Department of General Practice, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
- Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
| | - Yang Li
- Department of General Practice, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
- Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
| | - Jianli Ge
- Department of General Practice, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
- Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
| | - Xiaotong Guo
- Department of General Practice, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
- Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
| | - Yue Liu
- Department of General Practice, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
- Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
| | - Hua Jiang
- Department of General Practice, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
- Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
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Fralick M, Sholzberg M. Pharmacologic Thromboprophylaxis for Patients Admitted to General Medicine - Is It Necessary? NEJM EVIDENCE 2022; 1:EVIDtt2200085. [PMID: 38319277 DOI: 10.1056/evidtt2200085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Necessity of Pharmacologic ThromboprophylaxisIt is a busy night on call, with 15 new admissions to general internal medicine. The senior resident checks over the admission orders, including low-molecular-weight heparin for venous thromboembolism prophylaxis. The resident wonders: Does everyone admitted to general medicine really require pharmacologic thromboprophylaxis?
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Affiliation(s)
- Michael Fralick
- Division of General Internal Medicine, Department of Medicine, Sinai Health, Toronto
| | - Michelle Sholzberg
- Division of Hematology, Department of Medicine, St. Michael's Hospital, Toronto
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Chamoun N, Matta S, Aderian SS, Salibi R, Salameh P, Tayeh G, Haddad E, Ghanem H. A Prospective Observational Cohort of Clinical Outcomes in Medical Inpatients prescribed Pharmacological Thromboprophylaxis Using Different Clinical Risk Assessment Models(COMPT RAMs). Sci Rep 2019; 9:18366. [PMID: 31797897 PMCID: PMC6892868 DOI: 10.1038/s41598-019-54842-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 11/19/2019] [Indexed: 11/30/2022] Open
Abstract
The Caprini and Padua venous thromboembolism (VTE) risk assessment models (RAMs) are used to assess VTE risk in surgical and in medical patients respectively. This study aims to compare the proportion of medical inpatients eligible for VTE prophylaxis using the hospital Caprini-based RAM to using the Caprini and Padua RAMs and to assess the associated clinical outcomes. In a prospective observational study, we assessed 297 adult medical inpatients for whom VTE thromboprophylaxis was initiated according to the hospital Caprini-based RAM, referred to as the Lebanese American University Medical Center RAM (LAUMC-RAM). The Padua, Caprini and IMPROVE bleeding risk scores were also assessed for all patients. Bleeding and thromboembolism were evaluated at 14 and 30 days post VTE risk assessment. Pharmacologic thromboprophylaxis was warranted in 97.6%, 99.7%, and 52.9% of patients using the Caprini-based, Caprini, and Padua RAMs respectively. The Caprini-based and Caprini RAMs were highly correlated (r = 0.873 p < 0.001) and were significantly less correlated with the Padua RAM. Major and overall bleeding occurred in 1.4% and 9.2% respectively. VTE was reported in 0.4% with no VTE related mortality. In hospitalized medical patients, the Caprini-based RAM can accurately distinguish low and high VTE risk without resulting in increased risk of bleeding.
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Affiliation(s)
- Nibal Chamoun
- Lebanese American University School of Pharmacy, Byblos, Lebanon.
| | - Stephanie Matta
- Pharmacy Department, Lebanese American University Medical Center - Rizk Hospital, Beirut, Lebanon
| | | | - Rami Salibi
- Department of Pulmonary/Critical Care/Internal Medicine, Lebanese American University Medical Center - Rizk Hospital, Beirut, Lebanon
| | - Pascale Salameh
- Lebanese University, Faculty of Pharmacy, Hadath, Lebanon.,Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie (INSPECT-LB), Beirut, Lebanon
| | - Gaby Tayeh
- Lebanese American University School of Pharmacy, Byblos, Lebanon
| | - Elie Haddad
- Department of Cardiology, Lebanese American University Medical Center - Rizk Hospital, Beirut, Lebanon
| | - Hady Ghanem
- Department of Hematology/Oncology, Lebanese American University Medical Center - Rizk Hospital, Beirut, Lebanon
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Cortes D, Leung J, Ryl A, Lieu J. Pharmacy Informatics: Where Medication Use and Technology Meet. Can J Hosp Pharm 2019; 72:320-326. [PMID: 31452544 PMCID: PMC6699873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Daniel Cortes
- BScPhm, RPh, is with the Pharmacy Department and Clinical Informatics, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario BScPhm, RPh, is with the Pharmacy Department and Clinical Informatics, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario BScPhm, RPh, is with the Pharmacy Department, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario BScPhm, ACPR, RPh, is with Clinical Informatics, St Joseph's Health Centre, Unity Health Toronto, Toronto, Ontario
| | - Jodie Leung
- BScPhm, RPh, is with the Pharmacy Department and Clinical Informatics, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario BScPhm, RPh, is with the Pharmacy Department and Clinical Informatics, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario BScPhm, RPh, is with the Pharmacy Department, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario BScPhm, ACPR, RPh, is with Clinical Informatics, St Joseph's Health Centre, Unity Health Toronto, Toronto, Ontario
| | - Andrea Ryl
- BScPhm, RPh, is with the Pharmacy Department and Clinical Informatics, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario BScPhm, RPh, is with the Pharmacy Department and Clinical Informatics, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario BScPhm, RPh, is with the Pharmacy Department, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario BScPhm, ACPR, RPh, is with Clinical Informatics, St Joseph's Health Centre, Unity Health Toronto, Toronto, Ontario
| | - Jenny Lieu
- BScPhm, RPh, is with the Pharmacy Department and Clinical Informatics, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario BScPhm, RPh, is with the Pharmacy Department and Clinical Informatics, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario BScPhm, RPh, is with the Pharmacy Department, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario BScPhm, ACPR, RPh, is with Clinical Informatics, St Joseph's Health Centre, Unity Health Toronto, Toronto, Ontario
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Marongiu F, Barcellona D. Has time come for the use of direct oral anticoagulants in the extended prophylaxis of venous thromboembolism in acutely ill medical patients? No. Intern Emerg Med 2018; 13:1015-1018. [PMID: 29594815 DOI: 10.1007/s11739-018-1843-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 03/21/2018] [Indexed: 11/30/2022]
Abstract
Acutely ill hospitalized medical patients are at high risk of venous thromboembolism (VTE). Although thromboprophylaxis in these patients is recommended since 2004 by the American College of Chest Physicians, it is widely underused. The doubt as to whether or not to treat patients at high VTE risk after hospital discharge came from the knowledge that this risk may persist after the hospital admission period. Two meta-analyses comparing extended- versus short-duration prophylaxis are published. The results demonstrate an unfavorable balance between VTE prevention and incidence of major bleeding in patients assigned to extended-duration thromboprophylaxis. Only in the APEX study, betrixaban, a direct inhibitor of factor Xa, shows similar efficacy and safety compared to enoxaparin. However, while it is very promising, oral anticoagulant phase III studies and post-marketing registers are lacking. Moreover, betrixaban has a long half-life, an excretion in the gut by means of P-glycoprotein, and the lack of an antidote. These characteristics and the meta-analysis results prompt us to answer no to the extended thromboprophylaxis in hospitalized medical patients, at least now.
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Affiliation(s)
- Francesco Marongiu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Doris Barcellona
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
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