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在医疗住院患者中过度使用和不足使用血栓预防药物
Barbara Kocher1, Pauline Darbellay Farhoumand2, Damiana Pulver1
1Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Research and practice in thrombosis and haemostasis
|September 25, 2023
概括
在医疗住院患者的VTE预防中,风险评估模型的差异很大. 血栓预防 (TPX) 在高风险患者中使用不足,在低风险患者中使用过多,突出了对标准化风险分层的需求.
科学领域:
- 内部医学 内部医学
- 心脏病学 心脏病学
- 关键护理医学 关键护理医学
背景情况:
- 推对高风险的医疗住院患者进行血栓预防 (TPX),以预防静脉血栓塞栓症 (VTE).
- 验证的风险评估模型 (RAM) 用于VTE风险分层.
- 在RAMs的分类和对TPX适当性的影响中存在的差异并未得到充分理解.
研究的目的:
- 评估使用不同验证的RAM的医疗住院患者之间VTE风险分类的变化.
- 根据RAM分配的风险水平来确定TPX处方的适当性.
- 在医疗住院患者中识别TPX的潜在不足和过度使用.
主要方法:
- 在3家瑞士大学医院对1352名急性病患者进行前性队列研究.
- 使用四个验证的RAM进行静脉瘤风险分层:帕多瓦,简化和原始日内瓦分数,以及国际静脉血栓栓塞瘤预防医学注册 (IMPRINT) 分数.
- 在基线时对TPX处方的评估,适当性定义为高风险患者的TPX和低风险患者没有TPX.
主要成果:
- 高风险患者的比例从29.8% (IMPRINT) 到66.1% (原始日内瓦得分) 不同.
- 在所有RAM中,只有24.6%和26.3%的患者被一致分类为高风险或低风险.
- 在高风险患者中,TPX的适用程度在58.7%至63.3%之间 (36.7%至41.3%的使用不足),在低风险患者中为52.4%至62.8% (37.2%至47.6%的过度使用).
结论:
- 在医疗住院患者中,根据不同的RAM对VTE风险的分类存在显著的变化.
- 在RAM中,只有大约一半的患者实现了一致的风险分层.
- 在高风险患者中,TPX仍未得到充分使用,而在低风险患者中,过度使用更为普遍,这表明需要改进风险评估和TPX指南.
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