Prophylaxis of venous thromboembolism in hospitalized patients admitted from Spanish emergency departments: the PROTESU II study
Por:
Díaz, CR, Hernández, SJ, Chaib, FB, Abanto, AIC, Ayaso, MC, Polo, LL, Torrecillas, LG, Valle, HA, Velilla, MO, Jiménez, D, Lecumberri, R, Artacho, PR
Publicada:
1 ago 2024
Resumen:
Objectives. To estimate the prevalence of inappropriate use of prophylaxis to prevent venous thromboembolism (VTE) in patients with medical diseases admitted to hospital from the emergency department. To explore variables associated with inappropriate thromboprophylaxis.
Methods. Prospective multicenter cohort study in 15 hospital emergency departments. We included patients admitted for a medical condition during 7 days in the first quarter of 2022. We assessed risk for VTE with the Padua Prediction Score (PPS). Inappropriate thromboprophylaxis was defined by failure to prescribe prophylaxis in patients with a high-risk PPS assessment unless there were absolute contraindications (active bleeding or severe thrombopenia) or, alternatively, the prescription of prophylaxis in patients with a low-risk PPS assessment or absolute contraindications. A logistic regression model was adjusted for risk level to identify variables associated with inappropriate use of thromboprophylaxis.
Results. Of a total of 630 patients included, 450 (71.4%) had PPS scores indicating high risk for VTE; 180 patients were at low risk. Thromboprophylaxis was inappropriate in 248 patients (39.4%): 165 high-risk patients who received no prophylaxis, 82 low-risk patients who were nonetheless treated, and 1 patient who was treated in spite of severe thrombopenia. Odds ratios (ORs) revealed that the variables associated with inappropriate use of thromboprophylaxis were trauma or recent surgery (OR, 5.53; 95% CI, 1.58-19.34), presence of factors indicating risk for bleeding (OR, 2.61; 95% CI, 1.44-4.73), and hospital admission for either urinary tract infection (OR, 2.29; 95% CI, 1.07-4.87) or gastrointestinal disease (OR, 4.30; 95% CI, 1.71-10.85).
Conclusions. The inappropriate use of thromboprophylaxis in Spanish emergency departments is high and associated with certain clinical characteristics.
Filiaciones:
Díaz, CR:
Clin Univ Navarra, Dept Med Interna, C Marquesado Santa Marta 1, Madrid, Spain
Hernández, SJ:
Hosp Clin Barcelona, Area Urgencias, IDIBAPS, Barcelona, Spain
Chaib, FB:
Complejo Asistencial Soria, Serv Urgencias, Soria, Spain
Univ Valladolid, Fac Ciencias Salud, Valladolid, Spain
Abanto, AIC:
Hosp Univ Joan XXIII, Serv Urgencias, Tarragona, Spain
Ayaso, MC:
Hosp Clin Univ Santiago, Serv Urgencias, La Coruna, Spain
Polo, LL:
Hosp Santa Creu & Sant Pau, Serv Urgencias, Barcelona, Spain
Torrecillas, LG:
Hosp Univ Virgen Arrixaca, Serv Med Interna, Murcia, Spain
Valle, HA:
Hosp Univ Marques Valdecilla, Serv Urgencias, Santander, Cantabria, Spain
Inst Invest Sanitaria Valdecilla IDIVAL, Grp Salud Comunitaria, Santander, Spain
Velilla, MO:
Clin Univ Navarra, Dept Med Interna, C Marquesado Santa Marta 1, Madrid, Spain
Jiménez, D:
Hosp Ramon & Cajal, Inst Ramon y Cajal Invest Sanitaria IRYCIS, Serv Neumol, Madrid, Spain
Univ Alcala, Dept Med, Madrid, Spain
CIBER Enfermedades Resp CIBERES, Madrid, Spain
Lecumberri, R:
Univ Navarra Clin, Serv Hematol, Pamplona, Navarra, Spain
CIBER CV, Madrid, Spain
Artacho, PR:
Clin Univ Navarra, Dept Med Interna, C Marquesado Santa Marta 1, Madrid, Spain
CIBER Enfermedades Resp CIBERES, Madrid, Spain
Univ Navarra, Interdisciplinar Teragnosis & Radios INTRA Res Gr, Pamplona, Spain
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