随机对照试验表明，预防性剂量的抗凝剂可有效预防血栓栓塞风险高的住院患者发生静脉血栓栓塞 (VTE)。然而，目前还没有关于预防性抗凝剂使用的现实世界流行率的前瞻性研究。这项前瞻性研究旨在确定未选择的医疗部门住院患者人群中血栓预防的发生率和预测因素。我们进行了一项多中心前瞻性观察研究（AURELIO - 急性病住院患者静脉血栓形成率），以评估深静脉血栓形成率在入院和出院时使用压缩超声（CUS）对住院内科病房的未经选择的急性疾病患者进行血栓形成（DVT）分析。此外，我们评估了该人群的药物血栓预防用药率，并通过评估 RAM（风险评估模型）（例如临床医生决定进行血栓预防后的 IMPROVE-VTE 和 PADUA 评分）来分析血栓形成风险。 IMPROVE-VTE评分≥3和/或PADUA评分≥4的患者被归类为血栓形成高风险； IMPROVE-VTE 评分 <3 和/或 PADUA 评分 <4 的患者被归类为低风险。我们招募了 2371 名患者（1233 名男性 [52%] 和 1138 名女性 [48%]；平均年龄 72 ± 16 岁）。住院时间中位数为 13 ± 12 天。总体而言，442/2371 (18.6%) 名患者在入院时接受了预防性肠外抗凝剂（皮下注射低分子量分子肝素或磺达肝素，每日一次）。在评估招募人群的血栓形成风险时，1016 名（42.9%）患者被归类为高风险，1354 名（57.1%）患者被归类为低风险。在高危患者中，339/1016 (33.4%) 接受了抗凝预防治疗，而低危患者则为 103/1354 (7.6%)。住院期间，9例患者出现DVT，其中7例无症状，2例有症状近端DVT。其中，3 名患者正在接受抗凝预防，而 6 名则没有。在高危人群中，1016 名患者中有 7 名 (0.7%) 在住院期间经历了近端 DVT，其中 7 名患者中有 2 名 (28%) 接受了抗凝血栓预防。在低风险人群中，1354 名患者中有 2 名 (0.2%) 发生 DVT，其中 2 名患者中有 1 名 (50%) 接受抗凝血栓预防。接受预防治疗的患者中，年龄、心脏或呼吸衰竭、肺炎、活动性肿瘤、既往静脉血栓栓塞、活动能力下降和无肾衰竭的情况更为常见。多变量逻辑回归确定年龄（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）、活动性肿瘤（RR 2.041；CI 95%） 1222-2141；p < 0.0001）、肺炎（RR 1.618；CI 95% 1557-2676；p < 0.0001）、既往 VTE（RR 1.954；CI 95% 1222-3125；p < 0.0001）和活动能力下降（RR 4.674） ；CI 95% 3700-5905；p < 0.0001）作为血栓预防的独立预测因子。这项研究在没有预先建立血栓栓塞风险评分的情况下进行，提供了内科住院的急性疾病患者的静脉血栓栓塞预防的全面观点。它揭示了高龄、心脏或呼吸衰竭、活动性癌症、肺炎、既往 VTE 和活动能力下降是可能影响这些患者进行血栓预防的决定的预测因素。版权所有 © 2024 作者。由爱思唯尔有限公司出版。保留所有权利。

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.Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.