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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)
David Spirk   *
1   Medical Department, Sanofi-Aventis (Suisse) SA, Vernier, Switzerland
,
Mathieu Nendaz   *
2   Department of Internal Medicine, University Hospitals, Geneva, Switzerland
,
Drahomir Aujesky
3   Division of General Internal Medicine, Bern University Hospital, Bern, Switzerland
,
Daniel Hayoz
4   Department of Internal Medicine, Cantonal Hospital Fribourg, Fribourg, Switzerland
,
Jürg H. Beer
5   Department of Internal Medicine, Cantonal Hospital Baden, Baden, Switzerland
,
Marc Husmann
6   Clinic of Angiology, University Hospital Zurich, Zurich, Switzerland
,
Beat Frauchiger
7   Department of Internal Medicine, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland
,
Wolfgang Korte
8   Department of Internal Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
,
Walter A. Wuillemin
9   Division of Hematology and Central Hematology Laboratory, Cantonal Hospital Lucerne and University Bern, Lucerne, Switzerland
,
Marc Righini
10   Division of Angiology and Hemostasis, University Hospitals Geneva, Geneva, Switzerland
,
Henri Bounameaux
10   Division of Angiology and Hemostasis, University Hospitals Geneva, Geneva, Switzerland
,
Nils Kucher
11   Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland
› Author Affiliations Financial support: The study was funded by an unrestricted educational grant from the International Society on Thrombosis and Haemostasis (ISTH) 2007 Presidential Fund and Sanofi-Aventis (Suisse) SA, Vernier, Switzerland.
Further Information

Publication History

Received: 17 June 2014

Accepted after major revision: 02 January 2014

Publication Date:
24 November 2017 (online)

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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

* Both authors contributed equally.


 

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