Predictors of thromboprophylaxis in hospitalised medical patients. Explicit ASsessment of Thromboembolic RIsk and Prophylaxis for Medical PATients in SwitzErland (ESTIMATE).

Spirk, David; Nendaz, M; Aujesky, Drahomir; Hayoz, D; Beer, J H; Husmann, M; Frauchiger, B; Korte, W; Wuillemin, Walter Alfred; Righini, M; Bounameaux, H; Kucher, Nils (2015). Predictors of thromboprophylaxis in hospitalised medical patients. Explicit ASsessment of Thromboembolic RIsk and Prophylaxis for Medical PATients in SwitzErland (ESTIMATE). Thrombosis and haemostasis, 113(5), pp. 1127-1134. Schattauer 10.1160/TH14-06-0525

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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 high-risk patients. The use of thromboprophylaxis among low-risk patients was inconsistent, without clearly identifiable predictors, and should be addressed in further research.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Pharmacology
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Angiology

UniBE Contributor:

Spirk, David; Aujesky, Drahomir; Wuillemin, Walter Alfred and Kucher, Nils

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0340-6245

Publisher:

Schattauer

Language:

English

Submitter:

Catherine Gut

Date Deposited:

19 Mar 2015 10:41

Last Modified:

26 Jun 2016 01:58

Publisher DOI:

10.1160/TH14-06-0525

PubMed ID:

25608607

Uncontrolled Keywords:

Venous thromboembolism, internal medicine, risk assessment, thromboprophylaxis

BORIS DOI:

10.7892/boris.63369

URI:

https://boris.unibe.ch/id/eprint/63369

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