J.-F. Bergmann (1), A. T. Cohen (2), V. F. Tapson (3), S. Z. Goldhaber (4), A. K. Kakkar (5), B. Deslandes (6), W. Huang (7), F. A. Anderson Jr. (7)
for the ENDORSE Investigators
(1) Hôpital Lariboisière, University Paris 7, Paris, France; (2) King’s College Hospital, London, UK; (3) Duke University Medical Center, Durham, North Carolina, USA; (4) Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA; (5) Thrombosis Research Institute, London, UK and Queen Mary University of London, London, UK; (6) sanofi-aventis, Paris, France; (7) Center for Outcomes Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA
venous thromboembolism, prophylaxis, ACCP guideline use, ENDORSE, hospitalised medical patients
Limited data are available regarding the risk for venous thromboembolism (VTE) and VTE prophylaxis use in hospitalised medically ill patients. We analysed data from the global ENDORSE survey to evaluate VTE risk and prophylaxis use in this population according to diagnosis, baseline characteristics, and country. Data on patient characteristics, VTE risk, and prophylaxis use were abstracted from hospital charts. VTE risk and prophylaxis use were evaluated according to the 2004 American College of Chest Physicians (ACCP) guidelines. Multivariable analysis was performed to identify factors associated with use of ACCP-recommended prophylaxis. Data were evaluated for 37,356 hospitalised medical patients across 32 countries. VTE risk varied according to medical diagnosis, from 31.2% of patients with gastrointestinal/hepatobiliary diseases to 100% of patients with acute heart failure, active non-infectious respiratory disease, or pulmonary infection (global rate, 41.5%). Among those at risk for VTE, ACCP-recommended prophylaxis was used in 24.4% haemorrhagic stroke patients and 40–45% of cardiopulmonary disease patients (global rate, 39.5%). Large differences in prophylaxis use were observed among countries. Markers of disease severity, including central venous catheters, mechanical ventilation, and admission to intensive care units, were strongly associated with use of ACCP-recommended prophylaxis. In conclusion, VTE risk varies according to medical diagnosis. Less than 40% of at-risk hospitalised medical patients receive ACCP-recommended prophylaxis. Prophylaxis use appears to be associated with disease severity rather than medical diagnosis. These data support the necessity to improve implementation of available guidelines for evaluating VTE risk and providing prophylaxis to hospitalised medical patients.
Manuel Monreal1, Luis Peidro2, Carlos Resines3, Carlos Garcés4, José Luís Fernández5, Eduardo Garagorri6, Juan Carlos González7, for the NETCOT Investigators*
Thromb Haemost 2008 99 6: 1112-1115
Angeles Blanco-Molina1, Javier Trujillo-Santos2, Juan Criado1, Luciano Lopez1, Ramón Lecumberri3, Reyes Gutierrez4, Manuel Monreal5, for the RIETE Investigators*
Thromb Haemost 2007 97 2: 186-190
S. K. Haas1, V. Hach-Wunderle2, F. H. Mader3, W. D. Paar4
Phlebologie 2006 35 6: 286-288
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