内科病房中血栓预防的发生率与预测因素：AURELIO研究结果

随机对照试验表明，抗凝药物的预防剂量能有效预防住院高风险血栓栓塞事件（VTE）。然而，目前尚无关于实际临床中预防性抗凝药物使用普及率的前瞻性研究。本研究旨在评估未筛选的住院内科患者中血栓预防的发生率及预测因素。本研究为多中心前瞻性观察研究（AURELIO——急性病患者静脉血栓发生率）通过在入院和出院时使用压缩超声（CUS）检测深静脉血栓（DVT），评估未筛选的急性病患者血栓发生率。此外，分析了在临床医生决定是否给予抗凝预防治疗时，依据IMPROVE-VTE和PADUA评分的血栓风险评估。IMPROVE-VTE评分≥3和/或PADUA评分≥4者被归为高血栓风险；低风险为IMPROVE-VTE评分<3和/或PADUA评分<4。共招募2371例患者（男性1233例[52%]，女性1138例[48%]）；平均年龄72±16岁。住院天数中位数为13±12天。总共18.6%的患者（442/2371）在入院时接受了预防性肝素（皮下注射低分子量肝素或依诺肝素每日一次）。评估血栓风险后，1016例（42.9%）被归为高风险，1354例（57.1%）为低风险。在高风险组中，339例（33.4%）接受了抗凝预防治疗，而在低风险组中，只有103例（7.6%）接受了抗凝治疗。在住院期间，有9例患者发生DVT，其中7例为无症状，2例为近端DVT症状患者。其中3例患者在抗凝预防组，6例未接受抗凝。高风险人群中，有7例（0.7%）在住院期间发生近端DVT，其中2例（28%）接受了抗凝预防。在低风险人群中，有2例（0.2%）发生DVT，其中1例（50%）接受了抗凝预防。年龄、心脏或呼吸衰竭、肺炎、活动性恶性肿瘤、既往VTE、活动度降低及未伴有肾功能衰竭的患者在接受预防时更为频繁。多变量逻辑回归分析显示，年龄（RR 1.010；95% CI 1002-1019；p=0.015）、心/呼吸衰竭（RR 1.609；95% CI 1248-2075；p<0.0001）、活动性肿瘤（RR 2.041；95% CI 1222-2141；p<0.0001）、肺炎（RR 1.618；95% CI 1557-2676；p<0.0001）、既往VTE（RR 1.954；95% CI 1222-3125；p<0.0001）以及活动度降低（RR 4.674；95% CI 3700-5905；p<0.0001）是血栓预防的独立预测因素。本研究未预先设定血栓风险评分，全面反映了在内科住院急性患者中血栓预防的现状，揭示了高龄、心脏或呼吸衰竭、活动性肿瘤、肺炎、既往VTE及活动度降低等因素可能影响血栓预防的决策。

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.