Evaluation of deep vein thrombosis prophylaxis in a general hospital

Abstract Background Venous thromboembolism (VTE) is a cause for growing concern in hospitals, has great impact on morbidity and mortality in clinical and surgical patients, and is the leading cause of preventable hospital deaths. Although there are risk assessment models for hospital inpatients, prophylaxis is still underused or is administered incorrectly. Objectives To assess the risk profile for VTE in recently hospitalized clinical and surgical patients and evaluate the thromboprophylactic measures implemented in the first 24 hours of hospitalization. Methods Cross-sectional study conducted in a large general hospital in the state of São Paulo, Brazil, between March and July 2015. Padua and Caprini scores were used for risk stratification of clinical and surgical patients, respectively, while thromboprophylactic measures were analyzed for compliance with the recommendations contained in the 8th and 9th Consensus of the American College of Chest Physicians. Results A total of 592 patients (62% clinical and 38% surgical) were assessed. Risk stratification revealed a need for chemoprophylaxis in 42% of clinical patients and 81% of surgical patients (51% high risk and 30% moderate risk). However, 54% of high-risk clinical patients, 85% of high-risk surgical patients, and 4% of moderate-risk surgical patients, who were free from contraindications, were actually given the correct prophylaxis in the first 24 hours of hospitalization. Conclusions There is a need to improve patient safety in relation to VTE in the first hours of hospitalization, since there is underutilization of chemoprophylaxis, especially in high-risk clinical patients and moderate-risk surgical patients.

背景 静脉血栓栓塞症（Venous Thromboembolism, VTE）已成为医院内备受关注的健康问题，对临床与外科患者的发病率与死亡率影响显著，同时也是可预防的院内死亡首要诱因。尽管目前已有针对住院患者的风险评估模型，但血栓预防措施仍存在应用不足或给药不当的情况。
目的 评估近期住院的临床与外科患者的静脉血栓栓塞症风险特征，并分析患者住院首24小时内实施的血栓预防措施情况。
方法 本研究为横断面研究，于2015年3月至7月在巴西圣保罗州一家大型综合医院开展。临床患者与外科患者的风险分层分别采用Padua评分与Caprini评分；同时分析血栓预防措施是否符合美国胸科医师学会（American College of Chest Physicians, ACCP）第8、9版共识指南的推荐意见。
结果 共评估592例患者，其中临床患者占62%，外科患者占38%。风险分层结果显示，42%的临床患者与81%的外科患者需接受药物血栓预防，外科患者中51%为高危人群、30%为中危人群。但在无禁忌证的高危临床患者、高危外科患者以及中危外科患者中，仅54%、85%与4%的患者在住院首24小时内接受了规范的血栓预防措施。
结论 鉴于药物血栓预防措施存在应用不足的问题，尤其是高危临床患者与中危外科患者，需进一步提升住院早期静脉血栓栓塞症相关的患者安全管理水平。