内科病房中血栓预防的速度和预测因子：Aurelio研究的结果

随机对照试验表明，预防性抗凝剂的预防剂量可有效预防高血栓栓塞风险的住院医疗患者静脉血栓栓塞（VTE）。但是，关于预防性抗凝剂使用的现实世界流行率尚无前瞻性研究。这项前瞻性研究旨在确定在医疗部门住院的未选择患者人群中血栓预防的速度和预测因素。我们进行了多中心前瞻性观察研究（AURELIO-急性疾病患者的静脉血栓形成率），以评估未经医疗药物（DVT）在医疗疾病中评估（DVT）的这项疾病，并使用医疗疾病中的疾病来评估（DVT）。此外，我们评估了该人群中药理学血栓预防的速率，并通过评估临床医生决定管理血栓预防症后的RAMS（风险评估模型），例如RAMS（风险评估模型），例如Revor-VTE和PADUA分数。改善VTE评分≥3和/或PADUA评分≥4的患者被归类为高血小板风险； <3和/或Padua评分<4的改善VTE评分<4的人被归类为低风险。我们招募了2371例患者（1233名男性[52％]和1138名女性[48％]；平均年龄为72±16岁）。住院时间的中间长度为13±12天。总体而言，442/2371（18.6％）的患者每天接受预防性肠胃外抗凝剂（皮下低体重分子肝素或脂肪帕诺）。评估招募人口的血栓形成风险为1016（42.9％）的患者被归类为高风险，而1354（57.1％）的风险很低。在高危患者中，有339/1016（33.4％）接受抗凝剂预防，而低危患者（7.6％）（7.6％）。在住院期间，有9例患者患有DVT，包括7例无症状和2例有症状的DVT病例。其中，有3例患者进行了抗凝预防，而6例则没有。在高危人群中，住院期间有1016名患者中有7名（0.7％）经历了近端DVT，其中7例（28％）中有2例接受了抗凝抗凝药物预防。在低风险人群中，1354例患者中有2例（0.2％）出现DVT，其中2例（50％）接受了抗凝药物预防。年龄，心脏或呼吸衰竭，肺炎，活跃的肿瘤，以前的VTE，迁移率降低和缺乏肾衰竭的患者在接受预防的患者中更常见。多变量逻辑回归确定的年龄（RR 1.010; CI 95％1002-1019; P = 0.015），心脏/呼吸衰竭（RR 1.609; CI 95％1248-2075; P <0.0001; P <0.0001），主动Neoplasia（RR 2.041; CI 95％; CI 95％; CI 95％1222-2141; p <0.000 000 000 000 000 000 000 000 000年; 1.618; CI 95％1557-2676;血栓栓塞风险得分，在内科医学部门住院的急性疾病的医疗患者中，可以全面了解预防静脉血栓栓塞。它表明，高级年龄，心脏或呼吸衰竭，活性癌，肺炎，以前的VTE和迁移率降低是可能影响这些患者进行血栓预防的决定的预测因子。

Randomized controlled trials suggest that prophylactic doses of anticoagulants effectively prevent venous thromboembolism (VTE) in hospitalized medical patients with high thromboembolic risk. However, no prospective studies exist regarding the real-world prevalence of prophylactic anticoagulant use. This prospective study aimed to determine the rate and predictors of thromboprophylaxis in an unselected population of patients hospitalized in medical departments.We conducted a multicenter prospective observational study (AURELIO - rAte of venous thrombosis in acutely iLl patIents hOspitalized) to assess the rate of deep vein thrombosis (DVT) in unselected acutely ill patients hospitalized in medical wards using compression ultrasound (CUS) at admission and discharge. Additionally, we evaluated the rate of pharmacological thromboprophylaxis administration in this population and analyzed the thrombotic risk by assessing RAMs (Risk Assessment Models) such as the IMPROVE-VTE and PADUA scores following the clinician's decision to administer thromboprophylaxis. Patients with IMPROVE-VTE scores ≥3 and/or PADUA scores ≥4 were classified as high thrombotic risk; those with IMPROVE-VTE scores <3 and/or PADUA scores <4 were classified as low risk.We recruited 2371 patients (1233 males [52 %] and 1138 females [48 %]; mean age 72 ± 16 years). The median length of hospitalization was 13 ± 12 days. Overall, 442/2371 (18.6 %) patients received prophylactic parenteral anticoagulants (subcutaneous low weight molecular heparin or fondaparinux once daily) at admission. Assessing the thrombotic risk of the population recruited 1016 (42.9 %) patients were classified as high risk and 1354 (57.1 %) were low risk. Among high-risk patients, 339/1016 (33.4 %) received anticoagulant prophylaxis compared to 103/1354 (7.6 %) low-risk patients. During hospitalization, 9 patients developed DVT, comprising 7 asymptomatic and 2 symptomatic cases of proximal DVT. Of these, 3 patients were on anticoagulant prophylaxis, while 6 were not. Among the high-risk population, 7 out of 1016 patients (0.7 %) experienced proximal DVT during hospitalization, with 2 out of these 7 (28 %) receiving anticoagulant thromboprophylaxis. In the low-risk population, 2 out of 1354 patients (0.2 %) developed DVT, with 1 out of these 2 (50 %) receiving anticoagulant thromboprophylaxis. Age, heart or respiratory failure, pneumonia, active neoplasia, previous VTE, reduced mobility, and absence of kidney failure were more frequent in patients receiving prophylaxis. Multivariable logistic regression identified age (RR 1.010; CI 95 % 1002-1019; p = 0.015), heart/respiratory failure (RR 1.609; CI 95 % 1248-2075; p < 0.0001), active neoplasia (RR 2.041; CI 95 % 1222-2141; p < 0.0001), pneumonia (RR 1.618; CI 95 % 1557-2676; p < 0.0001), previous VTE (RR 1.954; CI 95 % 1222-3125; p < 0.0001), and reduced mobility (RR 4.674; CI 95 % 3700-5905; p < 0.0001) as independent predictors of thromboprophylaxis.This study, conducted without pre-established thromboembolic risk scores, offers a comprehensive view of venous thromboembolism prophylaxis in medical patients with acute conditions hospitalized in internal medicine departments. It reveals that advanced age, heart or respiratory failure, active cancer, pneumonia, previous VTE, and reduced mobility are predictors that may influence the decision to administer thromboprophylaxis in these patients.