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Updated: Feb 7, 2026

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以模型为指导的静脉血栓栓塞预防与现实实践的估计影响
Benjamin G Mittman1,2,3, Michael B Rothberg2,3
1Medical Scientist Training Program, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
Journal of hospital medicine
|February 6, 2026
概括
医疗住院患者的模式导向预防优化了静脉血栓塞栓症 (VTE) 和出血风险. 与临床医生的判断相比,这种方法可以减少不必要的预防,而不会增加整体事件率.
科学领域:
- 内部医学 内部医学
- 临床药理学 临床药理学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 美国血液学会 (ASH) 建议对静脉血栓栓塞 (VTE) 和出血进行风险评估,以指导医疗住院患者的预防.
- 使用风险模型指导VTE预防的临床有效性尚不清楚.
研究的目的:
- 以风险模型为指导的药理性VTE预防的风险模型与标准的临床医生的判断来比较VTE的发生率,严重出血和效率.
- 评估不同的基于模型的策略,包括帕多瓦,IMPROVE和克利夫兰诊所的模型.
主要方法:
- 这是一项回顾性研究,比较现实实践与在10家克利夫兰诊所医院的成年住院患者的假设模型导向预防 (2017年12月至2020年1月).
- 对每个策略的量化预防率,VTE事件,主要出血事件和需要治疗的人数 (NNT).
主要成果:
- 临床医生的判断导致了62%的患者进行预防;基于模型的策略推了17%-87%.
- 模型导向的预防显示出不同的结果,每1000名患者的总体事件从14.0-16.1不等,而实际实践中的事件为14.3.
- 与现实实践相比,最有效的基于模型的策略减少了55%的预防和0.14%的总事件,NNT为80.
结论:
- 临床处方VTE预防常常不合适,表明需要临床决策支持.
- 模式导向的预防通过减少不必要的治疗来提高效率,而不会影响VTE和出血事件的患者安全.
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