title: Predictors of thromboprophylaxis in hospitalised medical patients. Explicit ASsessment of Thromboembolic RIsk and Prophylaxis for Medical PATients in SwitzErland (ESTIMATE).
abstract: Both, underuse and overuse of thromboprophylaxis in hospitalised medical patients is common. We aimed to explore clinical factors associated with the use of pharmacological or mechanical thromboprophylaxis in acutely ill medical patients at high (Geneva Risk Score ≥ 3 points) vs low (Geneva Risk Score < 3 points) risk of venous thromboembolism. Overall, 1,478 hospitalised medical patients from eight large Swiss hospitals were enrolled in the prospective Explicit ASsessment of Thromboembolic RIsk and Prophylaxis for Medical PATients in SwitzErland (ESTIMATE) cohort study. The study is registered on ClinicalTrials.gov, number NCT01277536. Thromboprophylaxis increased stepwise with increasing Geneva Risk Score (p< 0.001). Among the 962 high-risk patients, 366 (38 %) received no thromboprophylaxis; cancer-associated thrombocytopenia (OR 4.78, 95 % CI 2.75-8.31, p< 0.001), active bleeding on admission (OR 2.88, 95 % CI 1.69-4.92, p< 0.001), and thrombocytopenia without cancer (OR 2.54, 95 % CI 1.31-4.95, p=0.006) were independently associated with the absence of prophylaxis. The use of thromboprophylaxis declined with increasing severity of thrombocytopenia (p=0.001). Among the 516 low-risk patients, 245 (48 %) received thromboprophylaxis; none of the investigated clinical factors predicted its use. In conclusion, in acutely ill medical patients, bleeding and thrombocytopenia were the most important factors for the absence of thromboprophylaxis among high-risk patients. The use of thromboprophylaxis among low-risk patients was inconsistent, without clearly identifiable predictors, and should be addressed in further research.
authors.forename: David
authors.initials: D
authors.lastname: Spirk
authors.forename: Mathieu
authors.initials: M
authors.lastname: Nendaz
authors.forename: Drahomir
authors.initials: D
authors.lastname: Aujesky
authors.forename: Daniel
authors.initials: D
authors.lastname: Hayoz
authors.forename: Jürg H
authors.initials: JH
authors.lastname: Beer
authors.forename: Marc
authors.initials: M
authors.lastname: Husmann
authors.forename: Beat
authors.initials: B
authors.lastname: Frauchiger
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Korte
authors.forename: Walter A
authors.initials: WA
authors.lastname: Wuillemin
authors.forename: Marc
authors.initials: M
authors.lastname: Righini
authors.forename: Henri
authors.initials: H
authors.lastname: Bounameaux
authors.affiliation: Nils Kucher, MD, Division of Vascular Medicine, Swiss Cardiovascular Center, Bern University Hospital, 3010 Bern, Switzerland, Tel.: +41 31 632 7963, Fax: +41 31 632 4380, E-Mail: kuchernils@yahoo.com.
authors.forename: Nils
authors.initials: N
authors.lastname: Kucher
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D005260:Female; D006470:Hemorrhage / Q000188:drug therapy / Q000517:prevention & control; D006760:Hospitalization; D006801:Humans; D007297:Inpatients; D007388:Internal Medicine / Q000592:standards; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D011446:Prospective Studies; D018570:Risk Assessment; D013557:Switzerland; D013921:Thrombocytopenia / Q000150:complications*; D054556:Venous Thromboembolism / Q000150:complications* / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants
keywords: Venous thromboembolism; internal medicine; risk assessment; thromboprophylaxis