Prophylaxis of Venous Thromboembolism after Hospital Discharge in Internal Medicine: Findings from the Observational FADOI-NoTEVole Study

Alessandro Squizzato; Giancarlo Agnelli; Mauro Campanini; Francesco Dentali; Francesca Agnelli; Erminio Bonizzoni; Alessandro Franco; Andrea Gallo; Gualberto Gussoni; Cinzia Nitti; Giuseppa Triolo; Antonella Valerio; Francesco Ventrella; Andrea Fontanella; for the FADOI-NoTEVole Study Group

doi:10.1055/s-0039-1697661

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2019; 119(12): 2043-2052
DOI: 10.1055/s-0039-1697661

Stroke, Systemic or Venous Thromboembolism

Georg Thieme Verlag KG Stuttgart · New York

Prophylaxis of Venous Thromboembolism after Hospital Discharge in Internal Medicine: Findings from the Observational FADOI-NoTEVole Study

Alessandro Squizzato

¹Department of Internal Medicine, University of Insubria, Varese, Italy

,

Giancarlo Agnelli

²Department of Internal and Cardiovascular Medicine-Stroke Unit, Hospital “S. Maria della Misericordia,” University of Perugia, Perugia, Italy

,

Mauro Campanini

³Department of Internal Medicine, Hospital “Maggiore della Carità,” Novara, Italy

,

Francesco Dentali

⁴Department of Internal Medicine, Hospital of Luino, ASST-Sette Laghi, University of Insubria, Varese, Italy

,

Francesca Agnelli

⁵Department of Internal Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

,

Erminio Bonizzoni

⁶Department of Clinical Science and Community, Section of Medical Statistics, Biometry and Epidemiology, Faculty of Medicine and Surgery, University of Milan, Milan, Italy

,

Alessandro Franco

⁷Department of Internal Medicine, Hospital “L. Parodi Delfino,” Colleferro, Rome, Italy

,

Andrea Gallo

¹Department of Internal Medicine, University of Insubria, Varese, Italy

,

Gualberto Gussoni

⁸Department of Research, FADOI Foundation, Milan, Italy

,

Cinzia Nitti

⁹Department of Emergency Medicine, AOU Hospital, Ancona, Italy

,

Giuseppa Triolo

¹⁰Department of Internal Medicine, Hospital “Villa Sofia,” Palermo, Italy

,

Antonella Valerio

⁸Department of Research, FADOI Foundation, Milan, Italy

,

Francesco Ventrella

¹¹Department of Internal Medicine, Hospital “G. Tatarella”- ASL-FG, Cerignola, FG, Italy

,

Andrea Fontanella

¹²Department of Medical, Hospital “Buon Consiglio-Fatebenefratelli,” Naples, Italy

,

for the FADOI-NoTEVole Study Group

› Author Affiliations

Abstract

Background and Aim Post-discharge prophylaxis for venous thromboembolism (VTE) is a challenging issue in patients hospitalised in Internal Medicine Units (IMUs). The aim of this study was to evaluate the frequency and the factors associated with post-discharge prophylaxis for VTE in IMUs.

Methods Multi-centre, retrospective study including consecutive patients who were admitted for any cause and discharged from an IMU.

Results Overall, 3,740 patients (mean age 74.1 ± 15.7 years) were included in the study at 38 IMUs in Italy. At discharge, the percentage of patients receiving pharmacological thromboprophylaxis was 16.0% (20.1% after excluding patients treated with anticoagulants for indications other than VTE prophylaxis). At multivariable analysis, history of ischaemic stroke, hypomobility ≥ 7 days, central venous catheter, ≥ 10 versus ≤ 5 days of hospital stay, use of corticosteroids, cancer, history of falls, availability of a caregiver, infections and age were significantly associated with thromboprophylaxis, while an inverse correlation was observed with concomitant anti-platelet drugs and platelet count < 70,000/mm³. Patients with a Padua Prediction Score ≥ 4 versus < 4 and with an IMPROVE bleeding score ≥ 7 versus < 7 more frequently received prophylaxis at discharge (31.2% vs. 10.6%, p < 0.0001, and 25.7% vs. 19.6%, p = 0.028, respectively).

Conclusion In this study, one in five patients discharged from an Italian IMU received prophylaxis for VTE. The perceived thrombotic risk is significantly related to the use of prophylaxis.

Keywords

prophylaxis for venous thromboembolism - Internal Medicine Units - post-discharge prophylaxis - predictors

Full Text

References

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