title: Assessment of thromboprophylaxis in medical patients hospitalized in Andalusia. A multicenter study.
abstract: OBJECTIVE
  Hospitalized patients are a population at risk for venous thromboembolism (VTE). The PRETEMED-2007 clinical practice guidelines help identify high-risk medical patients who are suited to thromboprophylaxis. These guidelines therefore provide a standard for prophylaxis in such patients. We evaluated the risk of VTE and the adjustment of thromboprophylaxis to the standards of the PRETEMED-2007 guidelines in patients hospitalized in internal medicine departments.
  
  
  METHODS
  An observational, cross-sectional multicenter study was performed in 2010 in 16 hospitals in Andalusia and included 20 consecutive patients per center. The study variables were age, sex, risk factors for VTE and hemorrhage, the risk-adjusted PRETEMED of VTE, adjustment of thromboembolic prophylaxis at admission and at discharge and hospital mortality.
  
  
  RESULTS
  The study included 293 patients (57.8% men) with a mean age of 69 (±15) years. The most common triggers for VTE were acute severe infection (27.3%) and neoplasia (16.4%). Some 43.4% of the patients presented a risk of hemorrhage. The risk of VTE at admission and discharge was high in 47.8% and 31% and moderate in 8.2% and 10.6%, respectively. A total of 91.7% and 17.3% of the patients underwent prophylaxis with low-molecular-weight heparin on admission and at discharge, respectively. The prescription was appropriate for 59.9% of the patients at admission (overutilization 38.4%, underutilization 1.7%) and for 74.7% at discharge (overutilization 5.4%, underutilization 19.9%). The adjustment was greater in patients older than 60 years and with greater hemorrhagic risk.
  
  
  CONCLUSIONS
  For 60% of the patients admitted to the departments of internal medicine in Andalusia, the thromboprophylaxis was appropriate. The inadequacy of thromboprophylaxis (40%) is mostly due to overutilization. These results suggest significant space for improvement.
authors.affiliation: Servicio de Medicina Interna, Hospital Universitario Valme, Sevilla, España.
authors.forename: M A
authors.initials: MA
authors.lastname: Navarro Puerto
authors.affiliation: Servicio de Medicina Interna, Hospital Universitario Virgen Rocío, Sevilla, España; IBIS-CSIC-US-CIBERESP, Sevilla, España.
authors.forename: F J
authors.initials: FJ
authors.lastname: Medrano Ortega
authors.affiliation: Servicio de Medicina Interna, Hospital Universitario Virgen Rocío, Sevilla, España.
authors.forename: R
authors.initials: R
authors.lastname: Izquierdo Guerrero
authors.affiliation: Servicio de Medicina Interna, Hospital Universitario Virgen Rocío, Sevilla, España; IBIS-CSIC-US-CIBERESP, Sevilla, España.
authors.forename: E
authors.initials: E
authors.lastname: Calderón Sandubete
authors.affiliation: Fundación Enebro, Sevilla, España.
authors.forename: M L
authors.initials: ML
authors.lastname: Buzón-Barrera
authors.affiliation: Servicio de Medicina Interna, Hospital Universitario Virgen Rocío, Sevilla, España; IBIS-CSIC-US-CIBERESP, Sevilla, España; Fundación Enebro, Sevilla, España. Electronic address: ignacio.marin.sspa@juntadeandalucia.es.
authors.forename: I
authors.initials: I
authors.lastname: Marín-León
keywords: Adecuación tratamiento; Clinical guidelines; Guías clínicas; Profilaxis; Prophylaxis; Treatment adjustment; Trombosis venosa; Venous thrombosis