[Prevalence and prevention of venous thromboembolic events in general practice. Multicenter, prospective cohort study].
OBJECTIVE
To determine the incidence of clinical venous thromboembolic events in home-care patients presenting an acute condition resulting in a significant and transitory reduction in mobility. To describe the measures implemented to prevent thromboembolic risks.


METHODS
Prospective, multicenter, observational cohort study conducted among 2,895 general practitioners randomly drawn, who included the first 6 eligible patients: outpatients aged 40 years and over in which a reduction in mobility longer than 48 hours was expected due to acute medical condition. The primary endpoint was the incidence of deep venous thrombosis and symptomatic pulmonary embolism at 3 weeks.


RESULTS
16,532 patients whose average age was 71 years were included between October 2002 and June 2003. The most common acute conditions resulting in a reduction in mobility were infections, acute rheumatologic diseases and falls without fracture. The incidences of deep venous thrombosis and symptomatic pulmonary embolism were respectively 1% (95% CI = 0.84-1.14) and 0.20% (95% CI = 0.13-0.27). Cancer and personal or family history of venous thromboembolic disease were independent risk factors for thromboembolic events. A thromboprophylaxis was initiated in 35% of patients. The main decisive factor for prescription was the personal history of venous thromboembolic disease.


CONCLUSIONS
The risk of symptomatic venous thromboembolic disease in outpatients whose mobility is reduced for medical reasons is close to that described in hospitalized patients.
Pouchain
Denis
D
Département de médecine générale, UFR Paris-Ouest, France. dpouchain@wanadoo.fr
Bergmann
Jean-François
JF
Bosson
Jean-Luc
JL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage*; D015331:Cohort Studies; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D005602:France / Q000453:epidemiology; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012107:Research Design; D012307:Risk Factors; D013923:Thromboembolism / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control*; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight