title: Combined assessment of thrombotic and haemorrhagic risk in acute medical patients.
abstract: Acute medical patients have a high risk of venous thromboembolic events (VTE). Unfortunately, the fear of bleeding complications limits the use of antithrombotic prophylaxis in this setting. To stratify the VTE and haemorrhagic risk, two clinical scores (PADUA, IMPROVE) have recently been developed. However, it is not clear how many patients have a concomitant high VTE and haemorrhagic risk and what is the use of prophylaxis in this situation. To clarify these issues we performed a prospective cohort study enrolling consecutive patients admitted to internal medicine. Patients admitted to internal medicine (January to December 2013) were included. VTE and haemorrhagic risk were evaluated in all the included patients. Use and type of anti-thrombotic prophylaxis was recorded. A total of 1761 patients (mean age 77.6 years) were enrolled; 76.8% (95% CI 74.7-78.7) were at high VTE risk and 11.9% (95% CI 10.4-13.5) were at high haemorrhagic risk. Anti-thrombotic prophylaxis was used in 80.5% of patients at high VTE risk and in 6.5% at low VTE risk (p<0.001), and in 16.6% at high haemorrhagic risk and in 72.5% at low haemorrhagic risk (p<0.001). Prophylaxis was used in 20.4% at both high VTE and haemorrhagic risk and in 88.9% at high VTE risk but low haemorrhagic risk. At multivariate-analysis, use of prophylaxis appeared highly influenced by the VTE risk (OR 68.2, 95% CI 43.1 - 108.0). In conclusion, many patients admitted to internal medicine were at high risk of VTE. Since almost 90% of them were at low haemorrhagic risk, pharmacological prophylaxis may be safely prescribed in most of these patients.
authors.affiliation: Micaela La Regina, Scalinata Fondega 12, 19121 La Spezia, Italy, Tel.: +39 0187 533394, E-mail: micaela.laregina@asl5.liguria.it.
authors.forename: Micaela
authors.initials: M
authors.lastname: La Regina
authors.forename: Francesco
authors.initials: F
authors.lastname: Orlandini
authors.forename: Francesca
authors.initials: F
authors.lastname: Marchini
authors.forename: Alessia
authors.initials: A
authors.lastname: Marinaro
authors.forename: Rosanna
authors.initials: R
authors.lastname: Bonacci
authors.forename: Paola
authors.initials: P
authors.lastname: Bonanni
authors.forename: Francesca
authors.initials: F
authors.lastname: Corsini
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Ceraudo
authors.forename: Edoarda
authors.initials: E
authors.lastname: Pacetti
authors.forename: Lucia
authors.initials: L
authors.lastname: Scuotri
authors.forename: Davide
authors.initials: D
authors.lastname: Costabile
authors.forename: Francesco
authors.initials: F
authors.lastname: Dentali
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D002309:Cardiology / Q000379:methods*; D005260:Female; D005343:Fibrinolytic Agents / Q000737:chemistry; D006470:Hemorrhage / Q000175:diagnosis*; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000175:diagnosis* / Q000188:drug therapy; D020246:Venous Thrombosis / Q000175:diagnosis / Q000188:drug therapy
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight
keywords: Anticoagulants; haemorrhage; internal medicine; prophylaxis; venous thromboembolism