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首页> 外文期刊>Open Journal of Internal Medicine >The Use of Low Molecular Weight Heparin for Venous Thromboembolism Prophylaxis in Medical Patients: How Much Are We Adherent to the Guidelines?
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The Use of Low Molecular Weight Heparin for Venous Thromboembolism Prophylaxis in Medical Patients: How Much Are We Adherent to the Guidelines?

机译：使用低分子量肝素预防医学患者的静脉血栓栓塞：我们在多少程度上遵守该指南？

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Background: Venous thromboembolism (VTE) is a common complication seen during or after hospitalization that manifests as deep venous thrombosis (DVT) and/or pulmonary embolism (PE). PE is considered the commonest preventable cause of death during and/or after hospitalization. Thus, pharmacological and mechanical methods are used to prevent VTE in hospitalized patients. Despite the availability of guidelines for VTE prophylaxis, it is crucial to assess the adherence and adaptation of the institution to these guidelines. Purpose: This study aimed to investigate adherence to the American College of Chest Physicians (ACCP) 2012 VTE prophylaxis guidelines in hospitalized medical patients in a tertiary care hospital in the United Arab Emirates. Methods: An observational prospective design was utilized in this study. To achieve the purpose, primary and secondary end points were identified to be the core of the investigation. The primary end points were: the incidence of bleeding, VTE, and cardiovascular events. While the secondary end points were: dose and indication validity for prophylaxis, VTE and bleeding risk assessments, adverse drug events (ADE) other than bleeding, appropriate monitoring when on low molecular weight heparin (LMWH) and the presence of contraindication at the time of prescribing LMWH. Results: 16 patients (20%) out of the total 80 met one or more of the primary end points. The vast majority of patients (81.25%) developed bleeding, while VTE was seen in one case only during hospitalization. 11 patients (13.75%) received LMWH while a contraindication was present. 15 patients (18.75%) who were prescribed LMWH had an International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) bleeding risk score of ≥7. However, 5 out of 13 patients (38.46%) who developed bleeding had a bleeding score of ≥7, and the relationship between bleeding score of ≥7 and the development of bleeding was statistically significant (p = 0.047). When investigating the doses that were utilized, 40% were prescribed an inappropriate dose. Conclusion: Various factors played a role in the inappropriateness of VTE prophylaxis such as; poor adherence to VTE guidelines, inappropriate dosing and monitoring, and not evaluating the bleeding risk. Hence, to be able to achieve effective VTE prophylaxis, these factors need to be addressed through adherence to and adaptation of the ACCP 2012 VTE prophylaxis guidelines.
机译：背景：静脉血栓栓塞（VTE）是住院期间或之后常见的并发症，表现为深静脉血栓形成（DVT）和/或肺栓塞（PE）。 PE被认为是住院期间和/或住院后最常见的可预防死亡原因。因此，使用药理和机械方法来预防住院患者的VTE。尽管有预防VTE的指南，但评估机构对这些指南的依从性和适应性至关重要。目的：本研究旨在调查在阿拉伯联合酋长国一家三级医院的住院医疗患者中遵守美国胸科医师学院（ACCP）2012 VTE预防指南的情况。方法：本研究采用观察性前瞻性设计。为了达到这个目的，主要和次要终点被确定为调查的核心。主要终点是：出血，VTE和心血管事件的发生率。次要终点为：预防的剂量和适应症，VTE和出血风险评估，除出血以外的不良药物事件（ADE），低分子量肝素（LMWH）时的适当监测以及在治疗时是否存在禁忌症规定LMWH。结果：在总共80名患者中，有16名患者（20％）达到了一个或多个主要终点。绝大多数患者（81.25％）发生了出血，而仅在住院期间就发现了VTE。有禁忌症的同时接受LMWH的患者为11名（13.75％）。处方LMWH的15例患者（18.75％）接受了国际医学预防静脉血栓栓塞（IMPROVE）出血风险评分≥7。然而，在发生出血的13名患者中，有5名（38.46％）的出血评分≥7，且出血评分≥7与出血发展之间的关系具有统计学意义（p = 0.047）。在调查使用剂量时，有40％的人服用了不适当的剂量。结论：各种因素在预防VTE的不当性中发挥了作用，例如：对VTE指南的依从性差，不适当的剂量和监测以及未评估出血风险。因此，为了能够有效地预防VTE，必须通过遵守和适应ACCP 2012 VTE预防指南来解决这些因素。

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