[Rationalization of risk factors for venous thromboembolism in medical inpatients. A prospective study].
BACKGROUND
In terms of preventive management of venous thromboembolism in medical inpatients, very large differences may be observed. Rationalization of behaviour requires the evaluation of simple and logical parameters, which takes into account both patient safety and economic considerations.


OBJECTIVE
The aim of this study was to evaluate a preventive scheme including the rationalization of the indications and the use of low molecular weight heparin.


METHODS



METHODS
Epidemiologic investigation.


METHODS
Patients hospitalized in five medical departments in the Hospital Center of Nantes, France.


METHODS
The risk of venous thromboembolism was rated as high, intermediate and low. Patients with high or intermediate risk were eligible for prevention therapy (table I).


METHODS
The main criterion was the occurrence during hospital stay of deep or superficial venous thrombosis of the lower limbs, pulmonary embolism, or unexplained sudden death. The screening was based on clinical features double-checked by venous doppler ultrasonography of the lower limbs and/or ventilation-perfusion lung scanning.


RESULTS
24,497 patients were eligible (table II), 15% were considered at risk and treated with Nadroparin, 6% had the same risk profile but were not treated and 14. 7% had low risk and no prevention. No bleeding event was reported. The incidence of venous thromboembolism was 0.75%, 1.7% and 0.14% respectively (p <0.01) (table III). This efficacy does not appear to depend on body weight or the existence of multiple risk factors observed (table IV and V).


CONCLUSIONS
This analysis of risk factors separates two populations with rates of incidence dramatically and significantly different. The prevention of venous thromboembolism by fixed dose of low molecular weight heparin remains justified since it reduces the risk of venous thromboembolism by a factor of 2.5.
Pottier
P
P
Service de Médecine Interne, CHU de Nantes, Hôtel-Dieu, 44093 Nantes Cedex 1.
Planchon
B
B
Truchaud
F
F
Pistorius
M A
MA
Furic
I
I
Grolleau
J Y
JY
D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D005602:France / Q000453:epidemiology; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D007297:Inpatients; D008875:Middle Aged; D017762:Nadroparin / Q000627:therapeutic use*; D011446:Prospective Studies; D012307:Risk Factors; D013923:Thromboembolism / Q000453:epidemiology* / Q000517:prevention & control; D020246:Venous Thrombosis / Q000453:epidemiology* / Q000517:prevention & control
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D017762:Nadroparin