对静脉血栓栓塞的风险评估模型的使用与预防的降低有关
Tarini Gunaratne1, Rebecca Schulte2, Stephanie Moss3
1Department of Internal Medicine, Ochsner Medical Center, New Orleans, LA, USA.
Journal of general internal medicine
|May 9, 2025
概括
一个风险评估模型 (RAM) 降低了静脉血栓塞栓症 (VTE) 预防的处方. 然而,许多低风险患者仍然接受了预防,这表明医生犹不决地拒绝治疗.
科学领域:
- 内部医学 内部医学
- 临床决策支持 临床决策支持
- 药理学 药理学是指药理学的学科.
背景情况:
- 静脉血栓塞栓症 (VTE) 预防常常被过度处方给低风险患者.
- 风险评估模型 (RAMs) 在降低低风险个体的VTE预防的有效性仍然不清楚.
- 一个经过验证的RAM被整合到入院订单组中,以指导医生对VTE风险评估.
研究的目的:
- 评估RAM在临床实践中的使用情况.
- 为了确定 RAM 使用与 VTE 预防处方之间的关联.
- 为了确定影响计算VTE风险和预防管理之间的一致性患者特征.
主要方法:
- 一项涉及10家美国医院 (131,441名医疗住院患者) 的横截面研究 (2020年12月 - 2023年3月).
- 排除标准包括手术患者,COVID-19患者,ICU患者以及具有禁忌或现有抗凝药的患者.
- 分析了医生RAM利用率,预防处方模式和患者人口统计数据.
主要成果:
- 医院间的RAM使用差异很大 (54-99%),整体医生一致性为68%.
- 使用RAM时 (44%) 与不使用RAM时 (73%,p < 0.001) 相比,处方预防的频率较低.
- 高风险患者 (>0.75%) 在96%的病例中接受了预防治疗,而低风险患者的比例为37%. 低风险患者的预防与男性性别,年龄较大,运动能力低下和并发症有关.
结论:
- 实施RAM与VTE预防处方减少相关.
- 尽管使用RAM,但显著比例的低风险患者继续接受预防,特别是那些具有特定VTE风险因素的患者.
- 医生表示同意高风险评估,但不愿意为低风险患者保留预防措施.
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