Predictors of thromboprophylaxis in hospitalised medical patients

David Spirk; Mathieu Nendaz; Drahomir Aujesky; Daniel Hayoz; Jürg H. Beer; Marc Husmann; Beat Frauchiger; Wolfgang Korte; Walter A. Wuillemin; Marc Righini; Henri Bounameaux; Nils Kucher

doi:10.1160/TH14-06-0525

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2015; 113(05): 1127-1134
DOI: 10.1160/TH14-06-0525

New Technologies, Diagnostic Tools and Drugs

Schattauer GmbH

Predictors of thromboprophylaxis in hospitalised medical patients

Explicit ASsessment of Thromboembolic RIsk and Prophylaxis for Medical PATients in SwitzErland (ESTIMATE)

Authors

David Spirk^*

¹Medical Department, Sanofi-Aventis (Suisse) SA, Vernier, Switzerland
Mathieu Nendaz^*

²Department of Internal Medicine, University Hospitals, Geneva, Switzerland
Drahomir Aujesky

³Division of General Internal Medicine, Bern University Hospital, Bern, Switzerland
Daniel Hayoz

⁴Department of Internal Medicine, Cantonal Hospital Fribourg, Fribourg, Switzerland
Jürg H. Beer

⁵Department of Internal Medicine, Cantonal Hospital Baden, Baden, Switzerland
Marc Husmann

⁶Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
Beat Frauchiger

⁷Department of Internal Medicine, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland
Wolfgang Korte

⁸Department of Internal Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
Walter A. Wuillemin

⁹Division of Hematology and Central Hematology Laboratory, Cantonal Hospital Lucerne and University Bern, Lucerne, Switzerland
Marc Righini

¹⁰Division of Angiology and Hemostasis, University Hospitals Geneva, Geneva, Switzerland
Henri Bounameaux

¹⁰Division of Angiology and Hemostasis, University Hospitals Geneva, Geneva, Switzerland
Nils Kucher

¹¹Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland

Abstract

summary

Both, underuse and overuse of thromboprophylaxis in hospitalised medical patients is common. We aimed to explore clinical factors associated with the use of pharmacological or mechanical thromboprophylaxis in acutely ill medical patients at high (Geneva Risk Score ≥ 3 points) vs low (Geneva Risk Score < 3 points) risk of venous thromboembolism. Overall, 1,478 hospitalised medical patients from eight large Swiss hospitals were enrolled in the prospective Explicit ASsessment of Thromboembolic RIsk and Prophylaxis for Medical PATients in SwitzErland (ESTIMATE) cohort study. The study is registered on ClinicalTrials. gov, number NCT01277536. Thromboprophylaxis increased stepwise with increasing Geneva Risk Score (p< 0.001). Among the 962 high-risk patients, 366 (38 %) received no thromboprophylaxis; cancer-associated thrombocytopenia (OR 4.78, 95 % CI 2.75–8.31, p< 0.001), active bleeding on admission (OR 2.88, 95 % CI 1.69–4.92, p< 0.001), and thrombocytopenia without cancer (OR 2.54, 95 % CI 1.31–4.95, p=0.006) were independently associated with the absence of prophylaxis. The use of thromboprophylaxis declined with increasing severity of thrombocytopenia (p=0.001). Among the 516 low-risk patients, 245 (48 %) received thromboprophylaxis; none of the investigated clinical factors predicted its use. In conclusion, in acutely ill medical patients, bleeding and thrombocytopenia were the most important factors for the absence of thromboprophylaxis among highrisk patients. The use of thromboprophylaxis among low-risk patients was inconsistent, without clearly identifiable predictors, and should be addressed in further research.

Keywords

Venous thromboembolism - internal medicine - risk assessment - thromboprophylaxis

Full Text

References

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