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Thromb Haemost. 2019 Oct 21. doi: 10.1055/s-0039-1697661. [Epub ahead of print]

Prophylaxis of Venous Thromboembolism after Hospital Discharge in Internal Medicine: Findings from the Observational FADOI-NoTEVole Study.

Author information

1
Department of Internal Medicine, University of Insubria, Varese, Italy.
2
Department of Internal and Cardiovascular Medicine-Stroke Unit, Hospital "S. Maria della Misericordia," University of Perugia, Perugia, Italy.
3
Department of Internal Medicine, Hospital "Maggiore della Carità," Novara, Italy.
4
Department of Internal Medicine, Hospital of Luino, ASST-Sette Laghi, University of Insubria, Varese, Italy.
5
Department of Internal Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
6
Department of Clinical Science and Community, Section of Medical Statistics, Biometry and Epidemiology, Faculty of Medicine and Surgery, University of Milan, Milan, Italy.
7
Department of Internal Medicine, Hospital "L. Parodi Delfino," Colleferro, Rome, Italy.
8
Department of Research, FADOI Foundation, Milan, Italy.
9
Department of Emergency Medicine, AOU Hospital, Ancona, Italy.
10
Department of Internal Medicine, Hospital "Villa Sofia," Palermo, Italy.
11
Department of Internal Medicine, Hospital "G. Tatarella"- ASL-FG, Cerignola, FG, Italy.
12
Department of Medical, Hospital "Buon Consiglio-Fatebenefratelli," Naples, Italy.

Abstract

BACKGROUND AND AIM:

 Post-discharge prophylaxis for venous thromboembolism (VTE) is a challenging issue in patients hospitalised in Internal Medicine Units (IMUs). The aim of this study was to evaluate the frequency and the factors associated with post-discharge prophylaxis for VTE in IMUs.

METHODS:

 Multi-centre, retrospective study including consecutive patients who were admitted for any cause and discharged from an IMU.

RESULTS:

 Overall, 3,740 patients (mean age 74.1 ± 15.7 years) were included in the study at 38 IMUs in Italy. At discharge, the percentage of patients receiving pharmacological thromboprophylaxis was 16.0% (20.1% after excluding patients treated with anticoagulants for indications other than VTE prophylaxis). At multivariable analysis, history of ischaemic stroke, hypomobility ≥ 7 days, central venous catheter, ≥ 10 versus ≤ 5 days of hospital stay, use of corticosteroids, cancer, history of falls, availability of a caregiver, infections and age were significantly associated with thromboprophylaxis, while an inverse correlation was observed with concomitant anti-platelet drugs and platelet count < 70,000/mm3. Patients with a Padua Prediction Score ≥ 4 versus < 4 and with an IMPROVE bleeding score ≥ 7 versus < 7 more frequently received prophylaxis at discharge (31.2% vs. 10.6%, p < 0.0001, and 25.7% vs. 19.6%, p = 0.028, respectively).

CONCLUSION:

 In this study, one in five patients discharged from an Italian IMU received prophylaxis for VTE. The perceived thrombotic risk is significantly related to the use of prophylaxis.

PMID:
31634959
DOI:
10.1055/s-0039-1697661

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