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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

Authors

  • Alessandro Squizzato

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

  • Giancarlo Agnelli

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

  • Mauro Campanini

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

  • Francesco Dentali

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

  • Francesca Agnelli

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

  • Erminio Bonizzoni

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

  • Alessandro Franco

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

  • Andrea Gallo

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

  • Gualberto Gussoni

    8   Department of Research, FADOI Foundation, Milan, Italy

  • Cinzia Nitti

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

  • Giuseppa Triolo

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

  • Antonella Valerio

    8   Department of Research, FADOI Foundation, Milan, Italy

  • Francesco Ventrella

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

  • Andrea Fontanella

    12   Department of Medical, Hospital “Buon Consiglio-Fatebenefratelli,” Naples, Italy
    • for the FADOI-NoTEVole Study Group

Funding Sanofi Italy supported the FADOI-NoTEVole study with an unrestricted research grant, and without involvement in planning, conduct, analysis and reporting of the study.
Further Information

Publication History

27 May 2019

09 August 2019

Publication Date:
21 October 2019 (online)

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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

Authors' Contributions

A.S., G.A., E.B., M.C., F.D., A.F., G.G. and A.V. defined the study design. A.S., G.G. and A.V. prepared the case report form. E.B., G.G. and A.V. performed data management and statistical analyses. A.S., G.A., F.A., M.C., F.D., A.F., A.F., A.G., C.N., G.T. and F.V. actively contributed to enrolment of patients. A.S., A.G., G.G. and A.V. wrote the paper. All authors reviewed the paper and agreed to submit it to Thrombosis and Haemostasis.


* See Supplementary Appendix A (available in the online version) for the list of Sites and Investigators.