title: An evaluation of thromboembolism prophylaxis in acutely ill medical patients.
abstract: OBJECTIVE
  To examine the frequency and adequacy of thromboprophylaxis in acutely ill medical patients hospitalised in a primary-tertiary care hospital.
  
  
  METHODS
  We carried out a cross-sectional study of 266 patients hospitalised in the three medical services of the University Hospital of Geneva. After exclusion of patients (64) treated by therapeutic anticoagulation, 202 patients were included. The appropriateness of thromboprophylaxis was assessed by means of explicit criteria developed by the Hôpital Lariboisière, Paris, France.
  
  
  RESULTS
  Overall, 87 patients (43.1%) received thromboprophylaxis. With explicit criteria, this percentage decreased to 37.6% (p = 0.25). According to the explicit criteria used, about half of the patients were unnecessarily treated, whereas 42% of the patients who should have been treated were not. Agreement between implicit criteria (or observed treatment rate) and explicit criteria assessed by kappa coefficient is 0.2. Two services (A, B) had an overuse of thromboprophylaxis (p = 0.002) and service C tended to under-use thromboprophylaxis (p = 0.45).
  
  
  CONCLUSIONS
  Even though the appropriateness of the applied explicit criteria has not been thoroughly validated, these results suggest that implicit criteria are associated with considerable uncertainty leading to both over or under-use of thromboprophylaxis. Further research is needed to better understand thromboembolic risk factors in acutely ill medical patients and to elaborate explicit evidence-based criteria for thromboprophylaxis in this setting.
authors.affiliation: Division of Angiology and Hemostasis, Department of Internal medicine, Geneva University Hospital, Switzerland.
authors.forename: Patricia
authors.initials: P
authors.lastname: Chmelik
authors.forename: Pierre
authors.initials: P
authors.lastname: Chopard
authors.forename: Henri
authors.initials: H
authors.lastname: Bounameaux
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D003422:Critical Care; D016638:Critical Illness; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011322:Primary Prevention / Q000379:methods*; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D017678:Sex Distribution; D015996:Survival Rate; D013557:Switzerland / Q000453:epidemiology; D013923:Thromboembolism / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D015912:Thrombolytic Therapy / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants