骨科患者的标准化血栓塞栓预防预防,以预防静脉血栓塞栓研究:为选择性关节和膝关节关节置换患者提供新的前性验证的电子风险分层工具
Scott C Woller1,2, Scott M Stevens1,2, James D Wylie3
1Department of Medicine, Intermountain Medical Center, Murray, Utah.
JB & JS open access
|November 4, 2025
概括
实施STOP-VTE模型改善了在部和膝关节置换术后遵守静脉血栓栓塞 (VTE) 预防指南. 这导致了VTE率和医疗保健成本的降低,同时增加了阿司匹林的使用.
科学领域:
- 整形外科手术 整形外科手术
- 血管医学 血管医学
- 医疗信息学 医疗信息学
背景情况:
- 静脉血栓塞栓症 (VTE),包括肺栓塞 (PE) 和深静脉血栓症 (DVT),是完全关节和膝关节置换 (THR/TKR) 后的一种重大并发症.
- 从历史上看,在THR/TKR患者的VTE预防中,建议使用抗凝血剂,而阿司匹林作为选择个体的潜在替代品.
- 关于有效的VTE风险分层存在有限的证据,以指导THR/TKR患者适当的血栓预防选择.
研究的目的:
- 实施和评估基于证据的电子健康记录 (EHR) 嵌入VTE风险评估模型,称为骨科患者标准化血栓栓塞预防以预防静脉血栓塞 (STOP-VTE).
- 评估STOP-VTE模型对遵守VTE预防指南和大型综合卫生系统中的临床结果的影响.
- 为了确定STOP-VTE实施后的VTE率,出血事件和医疗保健利用率的变化.
主要方法:
- 在23家医院开发并实施了STOP-VTE模型,将患者分为高风险或标准风险类别.
- 建议包括高风险患者的抗凝药 (例如,阿皮克萨班) 和标准风险患者的阿司匹林.
- 一项前性管理研究比较了38,207名患者在实施前2年 (基线) 和实施后6.8年 (干预) 的结果 (90天VTE,PE,DVT,死亡率,30天大出血,ED访问,住院).
主要成果:
- 在干预期间,遵守STOP-VTE指南的比例从基线57.4%显著增加到77.8% (p < 0.001).
- 90天VTE的发病率从0.9%降至0.65%,PE的发病率从0.7%降至0.39%,DVT的发病率从0.31%降至0.29%.
- 肺栓塞率,急诊室访问率和住院率显著下降,大出血率略有增加 (0%至0.04%).
结论:
- STOP-VTE指南已成功实施,并在卫生系统中得到广泛采用.
- 在STOP-VTE风险分层后,坚持化学预防与90天VTE和主要出血率的减少有关.
- 实施导致抗凝剂使用减少,阿司匹林使用增加,以及相关的成本节省.
相关概念视频
Venous Thrombosis III: Interprofessional Care
273
Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
273
Venous Thrombosis IV: Nursing Management
191
Nursing management begins with a thorough assessment of the patient's health history. Key factors include trauma to veins, peripherally inserted central catheters, varicose veins, recent pregnancy or childbirth, surgery, bacteremia, prolonged bed rest, atrial fibrillation, COPD, heart failure, cancer, coagulation disorders, myocardial infarction, spinal cord injury, stroke, prolonged travel, recent bone fractures, and dehydration. Review medication intake, particularly oral contraceptives,...
191
Venous Thrombosis II: Clinical Manifestations and Diagnostic Studies
282
The key difference between Superficial Vein Thrombosis (SVT) and Deep Vein Thrombosis (DVT) lies in their location and severity.Clinical ManifestationsSVT typically presents with localized pain, tenderness, and redness along the course of a superficial vein, often accompanied by a palpable, cord-like structure under the skin. This condition is usually less dangerous than DVT but can be uncomfortable and may lead to complications such as cellulitis or, rarely, a clot extension into the deep...
282
Venous Thrombosis I: Introduction
335
Venous thrombosis, the most common disorder of the veins, involves the formation of a thrombus or blood clot associated with vein inflammation. It can be classified as either superficial vein thrombosis or deep vein thrombosis.Superficial Vein Thrombosis: This involves the formation of a thrombus in a superficial vein, usually the greater or lesser saphenous vein. Though less severe than deep vein thrombosis (DVT), SVT can lead to complications if untreated.Deep Vein Thrombosis (DVT): This...
335
Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
298
Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
298
Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
2.1K
Oral anticoagulants are vital tools in preventing and treating blood clotting disorders. This diverse class of medications can be categorized as vitamin K antagonists, exemplified by warfarin, and direct thrombin inhibitors (DTIs), such as dabigatran, as well as factor Xa inhibitors, including rivaroxaban.
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
2.1K


