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Karamacoska D, Johnson T, Harrison L, Shi K, Akrawi J, D'Souza SP, Hohenberg MI, George ES, Steiner-Lim GZ. Venous thromboembolism risk screening, training and provider awareness in Australian residential aged care facilities. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5010-e5016. [PMID: 35855618 DOI: 10.1111/hsc.13915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 05/23/2022] [Accepted: 07/04/2022] [Indexed: 06/15/2023]
Abstract
Venous thromboembolism (VTE) is a leading cause of morbidity and mortality in the geriatric post-surgical population, and its prevention is a public health priority. The aim of this study was to assess the use of VTE risk screening and training protocols, and VTE awareness in the Australian residential aged care sector. A cross-sectional survey was conducted that was directed at facility and policy managers of community aged care facilities with ≥10 residents in two Australian states and territories. Forty-nine of 301 (16.3%) providers responded, representing 249/871 (28.6%) aged care facilities and 20,958/66,121 (31.7%) residents. VTE risk screening protocols were used by 1.2% of facilities (3/249), and 79.5% (198/249) were unaware that VTE is an issue in this population. Only 0.8% (2/249) were aware that risk screening and prophylaxis is required to prevent VTE; none were acting upon this. No facility had specific VTE risk assessment or prevention processes in place. Most residential aged care facilities surveyed do not have VTE risk screening protocols and were unaware of the risk that may be associated with this omission. These results have implications for development and implementation of national and international VTE risk screening guidelines in community care.
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Affiliation(s)
- Diana Karamacoska
- NICM Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Tamara Johnson
- School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
- Hornsby Ku-ring-gai Hospital, Northern Sydney Local Health District, Hornsby, New South Wales, Australia
| | - Lize Harrison
- School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
- Hornsby Ku-ring-gai Hospital, Northern Sydney Local Health District, Hornsby, New South Wales, Australia
| | - Kate Shi
- School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
| | - Joy Akrawi
- School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
| | - Stephanie P D'Souza
- School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
- Westmead Hospital, Western Sydney Local Health District, Westmead, New South Wales, Australia
| | - Mark I Hohenberg
- School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
| | - Emma S George
- School of Health Sciences, Western Sydney University, Penrith, New South Wales, Australia
- Translational Health Research Institute (THRI), Western Sydney University, Penrith, New South Wales, Australia
| | - Genevieve Z Steiner-Lim
- NICM Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
- Translational Health Research Institute (THRI), Western Sydney University, Penrith, New South Wales, Australia
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2
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Brüggemann RAG, Alnima T, Brouns SHA, Hanssen NMJ, Schols JMGA, Ten Cate H, Spaetgens B, Ten Cate-Hoek AJ. A known unknown? Pharmacological prevention of venous thromboembolism in nursing home residents. J Am Geriatr Soc 2021; 69:3338-3343. [PMID: 34423854 PMCID: PMC9291459 DOI: 10.1111/jgs.17422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/05/2021] [Accepted: 08/06/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Renée A G Brüggemann
- Department of Internal Medicine, Division of General Internal Medicine, Section Geriatric Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Teba Alnima
- Department of Internal Medicine, Division of General Internal Medicine, Section Geriatric Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Steffie H A Brouns
- Department of Internal Medicine, Division of General Internal Medicine, Section Geriatric Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Nordin M J Hanssen
- Amsterdam Diabetes Center, Department of Internal and Vascular Medicine, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Jos M G A Schols
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.,Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Hugo Ten Cate
- Department of Internal Medicine, Section Vascular Medicine and Thrombosis Expert Center, Maastricht University Medical Center+, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Bart Spaetgens
- Department of Internal Medicine, Division of General Internal Medicine, Section Geriatric Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Arina J Ten Cate-Hoek
- Department of Internal Medicine, Section Vascular Medicine and Thrombosis Expert Center, Maastricht University Medical Center+, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
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3
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Venous Thromboembolism in Cancer Patients on Simultaneous and Palliative Care. Cancers (Basel) 2020; 12:cancers12051167. [PMID: 32384641 PMCID: PMC7281278 DOI: 10.3390/cancers12051167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/29/2020] [Accepted: 05/02/2020] [Indexed: 12/25/2022] Open
Abstract
Simultaneous care represents the ideal integration between early supportive and palliative care in cancer patients under active antineoplastic treatment. Cancer patients require a composite clinical, social and psychological management that can be effective only if care continuity from hospital to home is guaranteed and if such a care takes place early in the course of the disease, combining standard oncology care and palliative care. In these settings, venous thromboembolism (VTE) represents a difficult medical challenge, for the requirement of acute treatments and for the strong impact on anticancer therapies that might be delayed or, even, totally discontinued. Moreover, cancer patients not only display high rates of VTE occurrence/recurrence but are also more prone to bleeding and this forces clinicians to optimize treatment strategies, balancing between hemorrhages and thrombus formation. VTE prevention is, therefore, regarded as a double-edged sword. Indeed, while on one hand the appropriate use of antithrombotic agents can reduce VTE occurrence, on the other it significantly increases the bleeding risk, especially in the frail patients who present with multiple co-morbidities and poly-therapy that can interact with anticoagulant drugs. For these reasons, thromboprophylaxis should start while active cancer treatment is ongoing, according to a simultaneous care model in a patient-centered perspective.
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Petterson TM, Smith CY, Emerson JA, Bailey KR, Ashrani AA, Heit JA, Leibson CL. Venous Thromboembolism (VTE) Incidence and VTE-Associated Survival among Olmsted County Residents of Local Nursing Homes. Thromb Haemost 2018; 118:1316-1328. [PMID: 29966167 DOI: 10.1055/s-0038-1660436] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Nursing home (NH) residency is an independent risk factor for venous thromboembolism (VTE), but the VTE burden within the NH population is uncertain. This study estimates VTE incidence and VTE-associated mortality among NH residents. We identified all NH residents in any NH in Olmsted County, Minnesota, United States, 1 October 1998 to 31 December 2005 and all first lifetime VTE among county residents to estimate VTE incidence while resident of local NHs (NHVTE), using Centers for Medicare and Medicaid Services Minimum Data Set and Rochester Epidemiology Project resources. We tested associations between NHVTE and age, sex and time since each NH admission using Poisson modelling. Additionally, we tested incident NHVTE as a potential predictor of survival using Cox proportional hazards, adjusting for age, sex and NH residency. Between 1 October 1998 and 31 December 2005, 3,465 Olmsted County residents with ≥1 admission to a local NH, contributed 4,762 NH stays. Of the 3,465 NH residents, 111 experienced incident NHVTE (2.3% of all eligible stays), for an overall rate of 3,653/100,000 NH person-years (NH-PY). VTE incidence was inversely associated with time since each NH admission, and was highest in the first 7 days after each NH admission (18,764/100,000 NH-PY). The adjusted hazard of death for incident NHVTE was 1.90 (95% confidence interval [CI]: 1.38-2.62). In conclusion, VTE incidence among NH residents was nearly 30-fold higher than published incidence rates for the general Olmsted County population. VTE incidence was highest within 7 days after NH admission, and NHVTE was associated with significantly reduced survival. These data can inform future research and construction of clinical trials regarding short-term prophylaxis.
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Affiliation(s)
- Tanya M Petterson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Carin Y Smith
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Jane A Emerson
- Division of Epidemiology, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Kent R Bailey
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Aneel A Ashrani
- Division of Hematology, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - John A Heit
- Division of Epidemiology, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, Minnesota, United States.,Division of Hematology, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, Minnesota, United States.,Department of Cardiovascular Diseases, College of Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Cynthia L Leibson
- Division of Epidemiology, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, Minnesota, United States
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Raskob G. Thrombosis: A major contributor to global disease burden. Thromb Haemost 2017; 112:843-52. [DOI: 10.1160/th14-08-0671] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 08/13/2014] [Indexed: 11/05/2022]
Abstract
SummaryThrombosis is a common pathology underlying ischaemic heart disease, ischaemic stroke, and venous thromboembolism (VTE). The Global Burden of Disease Study 2010 (GBD 2010) documented that ischaemic heart disease and stroke collectively caused one in four deaths worldwide. GBD 2010 did not report data for VTE as a cause of death and disability. We performed a systematic review of the literature on the global disease burden due to VTE in low, middle and high income countries. Studies from Western Europe, North America, Australia, and Southern Latin America (Argentina) yielded consistent results with annual incidences ranging from 0.75 to 2.69 per 1,000 individuals in the population. The incidence increased to between 2 and 7 per 1,000 among those 70 years of age or more. Although the incidence is lower in individuals of Chinese and Korean ethnicity, their disease burden is not low because of population aging. VTE associated with hospitalisation was the leading cause of disability-adjusted-lifeyears (DALYs) lost in low and middle income countries, and second in high income countries, responsible for more DALYs lost than nosocomial pneumonia, catheter-related blood stream infections, and adverse drug events. VTE causes a major burden of disease across low, middle, and high income countries. More detailed data on the global burden of VTE should be obtained to inform policy and resource allocation in health systems, and to evaluate if improved utilisation of preventive measures will reduce the burden.Note: The copyright for the article is being held by the International Society on Thrombosis and Haemostasis under a CC-BY-NC-ND license.
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Prophylaxis of Venous Thromboembolism in Home Care: An Integrative Review. Home Healthc Now 2017; 35:268-276. [PMID: 28471794 DOI: 10.1097/nhh.0000000000000534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Venous thromboembolism (VTE) is a set of diseases that carries both the risk of sudden death and long-term morbidity. Several studies conducted in Brazilian hospitals have identified that most patients considered at high risk for VTE do not receive prophylactic anticoagulant prescription properly. Risk of VTE in patients under home care is unknown. The objective of this integrative review is to identify evidence regarding prophylaxis of VTE in home care. The databases PubMed/Medline, LILACS, and National Guideline Clearinghouse were searched for articles published between January 1985 and June 2015. Although there is an extensive literature and clear guidelines for the prophylaxis and treatment of VTE in the hospital environment, studies on the same subject in home care are scarce, sometimes small, and almost exclusively based on retrospective collection of chart data. Additional research on VTE prophylaxis in the home care setting is needed in order to develop evidence-based practice guidelines.
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7
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Incidence of venous thromboembolism in care homes: a prospective cohort study. Br J Gen Pract 2017; 67:e130-e137. [PMID: 28093420 DOI: 10.3399/bjgp17x688873] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 10/10/2016] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Care home residents have venous thromboembolism (VTE) risk profiles similar to medical inpatients; however, the epidemiology of VTE in care homes is unclear. AIM To determine the incidence of VTE in care homes. DESIGN AND SETTING Observational cohort study of 45 care homes in Birmingham and Oxford, UK. METHOD A consecutive sample of care home residents was enrolled and followed up for 12 months. Data were collected via case note reviews of care home and GP records; mortality information was supplemented with Health and Social Care Information Centre (now called NHS Digital) cause of death data. All potential VTE events were adjudicated by an independent committee according to three measures of diagnostic certainty: definite VTE (radiological evidence), probable VTE (high clinical indication but no radiological evidence), or possible VTE (VTE cannot be ruled out). (Study registration number: ISTCTN80889792.) RESULTS: There were 1011 participants enrolled, and the mean follow-up period was 312 days (standard deviation 98 days). The incidence rate was 0.71 per 100 person years of observation (95% confidence interval [CI] = 0.26 to 1.54) for definite VTE, 0.83 per 100 person years (95% CI = 0.33 to 1.70) for definite and probable VTE, and 2.48 per 100 person years (95% CI = 1.53 to 3.79) for definite, probable, and possible VTE. CONCLUSION The incidence of VTE in care homes in this study (0.71-2.48 per 100 person years) is substantial compared with that in the community (0.117 per 100 person years) and in people aged ≥70 years (0.44 per 100 person years). Further research regarding risk stratification and VTE prophylaxis in this population is needed.
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8
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Raskob GE, Angchaisuksiri P, Blanco AN, Buller H, Gallus A, Hunt BJ, Hylek EM, Kakkar A, Konstantinides SV, McCumber M, Ozaki Y, Wendelboe A, Weitz JI. Thrombosis: a major contributor to global disease burden. Arterioscler Thromb Vasc Biol 2015; 34:2363-71. [PMID: 25304324 DOI: 10.1161/atvbaha.114.304488] [Citation(s) in RCA: 544] [Impact Index Per Article: 60.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Thrombosis is the common pathology underlying ischemic heart disease, ischemic stroke, and venous thromboembolism (VTE). The Global Burden of Disease Study 2010 (GBD 2010) documented that ischemic heart disease and stroke collectively caused 1 in 4 deaths worldwide. GBD 2010 did not report data for VTE as a cause of death and disability. OBJECTIVE To review the literature on the global burden of disease caused by VTE. APPROACH AND RESULTS We performed a systematic review of the literature on the global disease burden because of VTE in low-, middle-, and high-income countries. Studies from Western Europe, North America, Australia, and Southern Latin America (Argentina) yielded consistent results with annual incidences ranging from 0.75 to 2.69 per 1000 individuals in the population. The incidence increased to between 2 and 7 per 1000 among those aged ≥70 years. Although the incidence is lower in individuals of Chinese and Korean ethnicity, their disease burden is not low because of population aging. VTE associated with hospitalization was the leading cause of disability-adjusted life-years lost in low- and middle-income countries, and second in high-income countries, responsible for more disability-adjusted life-years lost than nosocomial pneumonia, catheter-related blood stream infections, and adverse drug events. CONCLUSIONS VTE causes a major burden of disease across low-, middle-, and high-income countries. More detailed data on the global burden of VTE should be obtained to inform policy and resource allocation in health systems and to evaluate whether improved use of preventive measures will reduce the burden.
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Affiliation(s)
- G E Raskob
- From the College of Public Health, University of Oklahoma Health Sciences Center (G.E.R., M.M., A.W.); Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (P.A.); División Hemostasia, Academia Nacional de Medicina, Buenos Aires, Argentina (A.N.B.); Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands (H.B.); SA Pathology-Department of Hematology, Flinders Medical Center, Adelaide, South Australia, Australia (A.G.); Thrombosis and Thrombophilia Centre, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom (B.J.H.); Boston University School of Medicine, MA (E.M.H.); Thrombosis Research Institute, London, United Kingdom (A.K.); Center for Thrombosis and Hemostasis, Johannes Gutenberg University, Mainz, Germany (S.V.K.); Department of Laboratory Medicine, University of Yamanashi, Tamaho, Yamanashi, Japan (Y.O.); and McMaster University and Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada (J.I.W.).
| | - P Angchaisuksiri
- From the College of Public Health, University of Oklahoma Health Sciences Center (G.E.R., M.M., A.W.); Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (P.A.); División Hemostasia, Academia Nacional de Medicina, Buenos Aires, Argentina (A.N.B.); Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands (H.B.); SA Pathology-Department of Hematology, Flinders Medical Center, Adelaide, South Australia, Australia (A.G.); Thrombosis and Thrombophilia Centre, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom (B.J.H.); Boston University School of Medicine, MA (E.M.H.); Thrombosis Research Institute, London, United Kingdom (A.K.); Center for Thrombosis and Hemostasis, Johannes Gutenberg University, Mainz, Germany (S.V.K.); Department of Laboratory Medicine, University of Yamanashi, Tamaho, Yamanashi, Japan (Y.O.); and McMaster University and Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada (J.I.W.)
| | - A N Blanco
- From the College of Public Health, University of Oklahoma Health Sciences Center (G.E.R., M.M., A.W.); Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (P.A.); División Hemostasia, Academia Nacional de Medicina, Buenos Aires, Argentina (A.N.B.); Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands (H.B.); SA Pathology-Department of Hematology, Flinders Medical Center, Adelaide, South Australia, Australia (A.G.); Thrombosis and Thrombophilia Centre, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom (B.J.H.); Boston University School of Medicine, MA (E.M.H.); Thrombosis Research Institute, London, United Kingdom (A.K.); Center for Thrombosis and Hemostasis, Johannes Gutenberg University, Mainz, Germany (S.V.K.); Department of Laboratory Medicine, University of Yamanashi, Tamaho, Yamanashi, Japan (Y.O.); and McMaster University and Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada (J.I.W.)
| | - H Buller
- From the College of Public Health, University of Oklahoma Health Sciences Center (G.E.R., M.M., A.W.); Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (P.A.); División Hemostasia, Academia Nacional de Medicina, Buenos Aires, Argentina (A.N.B.); Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands (H.B.); SA Pathology-Department of Hematology, Flinders Medical Center, Adelaide, South Australia, Australia (A.G.); Thrombosis and Thrombophilia Centre, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom (B.J.H.); Boston University School of Medicine, MA (E.M.H.); Thrombosis Research Institute, London, United Kingdom (A.K.); Center for Thrombosis and Hemostasis, Johannes Gutenberg University, Mainz, Germany (S.V.K.); Department of Laboratory Medicine, University of Yamanashi, Tamaho, Yamanashi, Japan (Y.O.); and McMaster University and Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada (J.I.W.)
| | - A Gallus
- From the College of Public Health, University of Oklahoma Health Sciences Center (G.E.R., M.M., A.W.); Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (P.A.); División Hemostasia, Academia Nacional de Medicina, Buenos Aires, Argentina (A.N.B.); Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands (H.B.); SA Pathology-Department of Hematology, Flinders Medical Center, Adelaide, South Australia, Australia (A.G.); Thrombosis and Thrombophilia Centre, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom (B.J.H.); Boston University School of Medicine, MA (E.M.H.); Thrombosis Research Institute, London, United Kingdom (A.K.); Center for Thrombosis and Hemostasis, Johannes Gutenberg University, Mainz, Germany (S.V.K.); Department of Laboratory Medicine, University of Yamanashi, Tamaho, Yamanashi, Japan (Y.O.); and McMaster University and Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada (J.I.W.)
| | - B J Hunt
- From the College of Public Health, University of Oklahoma Health Sciences Center (G.E.R., M.M., A.W.); Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (P.A.); División Hemostasia, Academia Nacional de Medicina, Buenos Aires, Argentina (A.N.B.); Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands (H.B.); SA Pathology-Department of Hematology, Flinders Medical Center, Adelaide, South Australia, Australia (A.G.); Thrombosis and Thrombophilia Centre, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom (B.J.H.); Boston University School of Medicine, MA (E.M.H.); Thrombosis Research Institute, London, United Kingdom (A.K.); Center for Thrombosis and Hemostasis, Johannes Gutenberg University, Mainz, Germany (S.V.K.); Department of Laboratory Medicine, University of Yamanashi, Tamaho, Yamanashi, Japan (Y.O.); and McMaster University and Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada (J.I.W.)
| | - E M Hylek
- From the College of Public Health, University of Oklahoma Health Sciences Center (G.E.R., M.M., A.W.); Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (P.A.); División Hemostasia, Academia Nacional de Medicina, Buenos Aires, Argentina (A.N.B.); Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands (H.B.); SA Pathology-Department of Hematology, Flinders Medical Center, Adelaide, South Australia, Australia (A.G.); Thrombosis and Thrombophilia Centre, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom (B.J.H.); Boston University School of Medicine, MA (E.M.H.); Thrombosis Research Institute, London, United Kingdom (A.K.); Center for Thrombosis and Hemostasis, Johannes Gutenberg University, Mainz, Germany (S.V.K.); Department of Laboratory Medicine, University of Yamanashi, Tamaho, Yamanashi, Japan (Y.O.); and McMaster University and Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada (J.I.W.)
| | - A Kakkar
- From the College of Public Health, University of Oklahoma Health Sciences Center (G.E.R., M.M., A.W.); Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (P.A.); División Hemostasia, Academia Nacional de Medicina, Buenos Aires, Argentina (A.N.B.); Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands (H.B.); SA Pathology-Department of Hematology, Flinders Medical Center, Adelaide, South Australia, Australia (A.G.); Thrombosis and Thrombophilia Centre, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom (B.J.H.); Boston University School of Medicine, MA (E.M.H.); Thrombosis Research Institute, London, United Kingdom (A.K.); Center for Thrombosis and Hemostasis, Johannes Gutenberg University, Mainz, Germany (S.V.K.); Department of Laboratory Medicine, University of Yamanashi, Tamaho, Yamanashi, Japan (Y.O.); and McMaster University and Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada (J.I.W.)
| | - S V Konstantinides
- From the College of Public Health, University of Oklahoma Health Sciences Center (G.E.R., M.M., A.W.); Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (P.A.); División Hemostasia, Academia Nacional de Medicina, Buenos Aires, Argentina (A.N.B.); Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands (H.B.); SA Pathology-Department of Hematology, Flinders Medical Center, Adelaide, South Australia, Australia (A.G.); Thrombosis and Thrombophilia Centre, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom (B.J.H.); Boston University School of Medicine, MA (E.M.H.); Thrombosis Research Institute, London, United Kingdom (A.K.); Center for Thrombosis and Hemostasis, Johannes Gutenberg University, Mainz, Germany (S.V.K.); Department of Laboratory Medicine, University of Yamanashi, Tamaho, Yamanashi, Japan (Y.O.); and McMaster University and Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada (J.I.W.)
| | - M McCumber
- From the College of Public Health, University of Oklahoma Health Sciences Center (G.E.R., M.M., A.W.); Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (P.A.); División Hemostasia, Academia Nacional de Medicina, Buenos Aires, Argentina (A.N.B.); Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands (H.B.); SA Pathology-Department of Hematology, Flinders Medical Center, Adelaide, South Australia, Australia (A.G.); Thrombosis and Thrombophilia Centre, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom (B.J.H.); Boston University School of Medicine, MA (E.M.H.); Thrombosis Research Institute, London, United Kingdom (A.K.); Center for Thrombosis and Hemostasis, Johannes Gutenberg University, Mainz, Germany (S.V.K.); Department of Laboratory Medicine, University of Yamanashi, Tamaho, Yamanashi, Japan (Y.O.); and McMaster University and Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada (J.I.W.)
| | - Y Ozaki
- From the College of Public Health, University of Oklahoma Health Sciences Center (G.E.R., M.M., A.W.); Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (P.A.); División Hemostasia, Academia Nacional de Medicina, Buenos Aires, Argentina (A.N.B.); Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands (H.B.); SA Pathology-Department of Hematology, Flinders Medical Center, Adelaide, South Australia, Australia (A.G.); Thrombosis and Thrombophilia Centre, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom (B.J.H.); Boston University School of Medicine, MA (E.M.H.); Thrombosis Research Institute, London, United Kingdom (A.K.); Center for Thrombosis and Hemostasis, Johannes Gutenberg University, Mainz, Germany (S.V.K.); Department of Laboratory Medicine, University of Yamanashi, Tamaho, Yamanashi, Japan (Y.O.); and McMaster University and Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada (J.I.W.)
| | - A Wendelboe
- From the College of Public Health, University of Oklahoma Health Sciences Center (G.E.R., M.M., A.W.); Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (P.A.); División Hemostasia, Academia Nacional de Medicina, Buenos Aires, Argentina (A.N.B.); Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands (H.B.); SA Pathology-Department of Hematology, Flinders Medical Center, Adelaide, South Australia, Australia (A.G.); Thrombosis and Thrombophilia Centre, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom (B.J.H.); Boston University School of Medicine, MA (E.M.H.); Thrombosis Research Institute, London, United Kingdom (A.K.); Center for Thrombosis and Hemostasis, Johannes Gutenberg University, Mainz, Germany (S.V.K.); Department of Laboratory Medicine, University of Yamanashi, Tamaho, Yamanashi, Japan (Y.O.); and McMaster University and Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada (J.I.W.)
| | - J I Weitz
- From the College of Public Health, University of Oklahoma Health Sciences Center (G.E.R., M.M., A.W.); Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (P.A.); División Hemostasia, Academia Nacional de Medicina, Buenos Aires, Argentina (A.N.B.); Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands (H.B.); SA Pathology-Department of Hematology, Flinders Medical Center, Adelaide, South Australia, Australia (A.G.); Thrombosis and Thrombophilia Centre, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom (B.J.H.); Boston University School of Medicine, MA (E.M.H.); Thrombosis Research Institute, London, United Kingdom (A.K.); Center for Thrombosis and Hemostasis, Johannes Gutenberg University, Mainz, Germany (S.V.K.); Department of Laboratory Medicine, University of Yamanashi, Tamaho, Yamanashi, Japan (Y.O.); and McMaster University and Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada (J.I.W.)
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Leibson CL, Petterson TM, Smith CY, Bailey KR, Emerson JA, Ashrani AA, Takahashi PY, Heit JA. Rethinking guidelines for VTE risk among nursing home residents: a population-based study merging medical record detail with standardized nursing home assessments. Chest 2014; 146:412-421. [PMID: 24626961 DOI: 10.1378/chest.13-2652] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Nursing home (NH) residents are at increased risk for both VTE and bleeding from pharmacologic prophylaxis. Construction of prophylaxis guidelines is hampered by NH-specific limitations with VTE case identification and characterization of risk. We addressed these limitations by merging detailed provider-linked Rochester Epidemiology Project (REP) medical records with Centers for Medicare and Medicaid Services Minimum Data Set (MDS) NH assessments. METHODS This population-based nested case-control study identified all Olmsted County, Minnesota, residents with first-lifetime VTE October 1, 1998, through December 31, 2005, while a resident of an NH (N = 91) and one to two age-, sex-, and calendar year-matched NH non-VTE control subjects. For each NH case without hospitalization 3 months before VTE (n = 23), we additionally identified three to four nonhospitalized NH control subjects. REP and MDS records were reviewed before index date (VTE date for cases; respective REP encounter date for control subjects) for numerous characteristics previously associated with VTE in non-NH populations. Data were modeled using conditional logistic regression. RESULTS The multivariate model consisting of all cases and control subjects identified only three characteristics independently associated with VTE: respiratory infection vs no infection (OR, 5.9; 95% CI, 2.6-13.1), extensive or total assistance with walking in room (5.6, 2.5-12.6), and general surgery (3.3, 1.0-10.8). In analyses limited to nonhospitalized cases and control subjects, only nonrespiratory infection vs no infection was independently associated with VTE (8.8, 2.7-29.2). CONCLUSIONS Contrary to previous assumptions, most VTE risk factors identified in non-NH populations do not apply to the NH population. NH residents with infection, substantial mobility limitations, or recent general surgery should be considered potential candidates for VTE prophylaxis.
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Affiliation(s)
- Cynthia L Leibson
- Division of Epidemiology, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
| | - Tanya M Petterson
- Division of Biomedical Statistics and Informatics, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Carin Y Smith
- Division of Biomedical Statistics and Informatics, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Kent R Bailey
- Division of Biomedical Statistics and Informatics, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Jane A Emerson
- Division of Epidemiology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Aneel A Ashrani
- Department of Health Sciences Research, and the Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Paul Y Takahashi
- Division of Primary Care, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - John A Heit
- Department of Health Sciences Research, and the Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN; Division of Cardiovascular Disease, Department of Internal Medicine, Mayo Clinic, Rochester, MN
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Abstract
Thrombosis is a common pathology underlying ischemic heart disease, ischemic stroke, and venous thromboembolism (VTE). The Global Burden of Disease Study 2010 (GBD 2010) documented that ischemic heart disease and stroke collectively caused one in four deaths worldwide. GBD 2010 did not report data for VTE as a cause of death and disability. We performed a systematic review of the literature on the global disease burden due to VTE in low, middle and high income countries. Studies from Western Europe, North America, Australia, and Southern Latin America (Argentina) yielded consistent results with annual incidences ranging from 0.75 to 2.69 per 1,000 individuals in the population. The incidence increased to between 2 and 7 per 1,000 among those 70 years of age or more. Although the incidence is lower in individuals of Chinese and Korean ethnicity, their disease burden is not low because of population aging. VTE associated with hospitalization was the leading cause of disability-adjusted-life-years (DALYs) lost in low and middle income countries, and second in high income countries, responsible for more DALYs lost than nosocomial pneumonia, catheter-related blood stream infections, and adverse drug events. VTE causes a major burden of disease across low, middle, and high income countries. More detailed data on the global burden of VTE should be obtained to inform policy and resource allocation in health systems, and to evaluate if improved utilization of preventive measures will reduce the burden.
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Raskob G, Angchaisuksiri P, Blanco A, Buller H, Gallus A, Hunt B, Hylek E, Kakkar A, Konstantinides S, McCumber M, Ozaki Y, Wendelboe A, Weitz J. Thrombosis: a major contributor to the global disease burden. J Thromb Haemost 2014; 12:1580-90. [PMID: 25302663 DOI: 10.1111/jth.12698] [Citation(s) in RCA: 285] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Indexed: 01/19/2023]
Abstract
Thrombosis is a common pathology underlying ischemic heart disease, ischemic stroke, and venous thromboembolism (VTE). The Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2010 documented that ischemic heart disease and stroke collectively caused one in four deaths worldwide. GBD 2010 did not report data for VTE as a cause of death and disability. We performed a systematic review of the literature on the global disease burden caused by VTE in low-income, middle-income and high-income countries. Studies from western Europe, North America, Australia and southern Latin America (Argentina) yielded consistent results, with annual incidence rates ranging from 0.75 to 2.69 per 1000 individuals in the population. The incidence increased to between 2 and 7 per 1000 among those aged ≥ 70 years. Although the incidence is lower in individuals of Chinese and Korean ethnicity, their disease burden is not low, because of population aging. VTE associated with hospitalization was the leading cause of disability-adjusted life-years (DALYs) lost in low-income and middle-income countries, and the second most common cause in high-income countries, being responsible for more DALYs lost than nosocomial pneumonia, catheter-related bloodstream infections, and adverse drug events. VTE causes a major burden of disease across low-income, middle-income and high-income countries. More detailed data on the global burden of VTE should be obtained to inform policy and resource allocation in health systems, and to evaluate whether improved utilization of preventive measures will reduce the burden.
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Reardon G, Pandya N, Nutescu EA, Lamori J, Damaraju C, Schein J, Bookhart B. Incidence of Venous Thromboembolism in Nursing Home Residents. J Am Med Dir Assoc 2013; 14:578-84. [DOI: 10.1016/j.jamda.2013.02.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 01/22/2013] [Accepted: 02/05/2013] [Indexed: 12/21/2022]
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Dharmarajan T, Norkus EP. Venous Thromboembolism Prophylaxis in the Nursing Home: To Do or Not To Do? J Am Med Dir Assoc 2013; 14:535-9. [DOI: 10.1016/j.jamda.2013.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 05/01/2013] [Indexed: 11/27/2022]
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Cátedra B, Muñoz F, Cabello L. [Are domiciliary care patients receiving adequate thromboprophylaxis?]. Semergen 2013; 40:27-33. [PMID: 23774029 DOI: 10.1016/j.semerg.2013.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Revised: 02/14/2013] [Accepted: 03/13/2013] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The study aims to determine the percentage of patients treated at home with an indication of prophylaxis of thromboembolic disease (TED) according to the PRETEMED guidelines and whether they receive such prophylaxis. MATERIALS AND METHODS A cross-sectional descriptive study was conducted in Segovia Palace Health Centre (Madrid). INCLUSION CRITERIA to be included in the domiciliary care protocol. EXCLUSION CRITERIA terminal patient, hospitalised or surgery in the last 3 months. The variables used include, age, sex, duration of domiciliary care, mobility, anticoagulant or antiplatelet treatment and reason, and associated and precipitating factors to calculate the risk of TED according to the PRETEMED guidelines, and if they receive such prophylaxis, by reviewing computerised medical records and meeting with the staff responsible. RESULTS The study included a total of 187 patients, of whom 81% were women There was a significant differences in mean age by sex (men, 76.91 years, 95% CI; 72.59-81.24, and women, 86.72 years, 95% CI; 72.59-81.24, P<.05). Almost two-thirds (65%) walked in the home. There were 3.7% patients who had an indication for receiving prophylaxis, but did not receive it, although 85.8% of them were on anticoagulants or antiplatelet therapy for other reasons. CONCLUSIONS Most patients in domiciliary care have a low baseline risk of developing a TED episode in our study. There should be more emphasis placed on the prophylaxis of TED in acute medical episodes in which patients with slightly elevated risk may increase the likelihood of TED. Observational studies should be conducted to study the baseline risk and the subsequent development of TED in the population receiving home care.
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Affiliation(s)
- B Cátedra
- Medicina de Familia y Comunitaria, Centro de Salud Palacio de Segovia, Servicio Madrileño de Salud, Madrid, España.
| | - F Muñoz
- Medicina de Familia y Comunitaria, Centro de Salud Palacio de Segovia, Servicio Madrileño de Salud, Madrid, España
| | - L Cabello
- Unidad Docente Multiprofesional Atención Familiar y Comunitaria Noroeste, Servicio Madrileño de Salud, Madrid, España
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Use of Warfarin Therapy Among Residents Who Developed Venous Thromboembolism in the Nursing Home. ACTA ACUST UNITED AC 2012; 10:361-72. [DOI: 10.1016/j.amjopharm.2012.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 11/01/2012] [Accepted: 11/07/2012] [Indexed: 11/20/2022]
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Leibson CL, Petterson TM, Smith CY, Bailey KR, Ashrani AA, Heit JA. Venous thromboembolism in nursing home residents: role of selected risk factors. J Am Geriatr Soc 2012; 60:1718-23. [PMID: 22880626 DOI: 10.1111/j.1532-5415.2012.04100.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To provide nursing home (NH)-specific estimates to assess whether venous thromboembolism (VTE) risk factors identified for the general population apply to NH residents. DESIGN Population-based case-control study. SETTING Olmsted County, Minnesota. PARTICIPANTS All county residents with symptomatic objectively diagnosed incident VTE while resident in a NH from 1988 through 2000 (N = 182) and two age-, sex-, calendar-year-matched non-VTE Olmsted County NH residents per case (N = 364). MEASUREMENTS Provider-linked medical records were reviewed to obtain information on active malignancy and recent hospitalization, surgery, trauma, or fracture as of index date (case's VTE date; respective provider registration date for controls). Risk factor prevalence and VTE-associated odds ratios (OR) were estimated and compared with previously obtained data for all Olmsted County residents from 1988 through 2000. For analyses, both groups were limited to individuals aged 65 and older. RESULTS In NH residents, active malignancy, recent hospitalization, and recent surgery significantly increased VTE risk, but the magnitude of risk appeared much lower than general population estimates (e.g., for major surgery, OR = 2.5, 95% confidence interval (CI) = 1.4-4.3 for NH residents vs OR = 11, 95% CI = 7.0-17 for general population). In general, the prevalence of all evaluated VTE risk factors appeared much higher in NH controls than in general population controls. Thromboprophylaxis rates appeared higher for NH cases and controls than in the general population; disconcertingly, 47% of NH cases received prophylaxis. CONCLUSION Although general population VTE risk factors (active cancer and recent hospitalization or surgery) can identify NH residents at higher risk for VTE, these exposures do not adequately stratify VTE risk for thromboprophylaxis recommendations. Further research into NH-specific risk factors and prophylaxis effectiveness is required.
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Affiliation(s)
- Cynthia L Leibson
- Divisions of Epidemiology, Department of Health Sciences Research, Mayo Clinic Rochester, Rochester, Minnesota 55905, USA.
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18
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Kahn SR, Lim W, Dunn AS, Cushman M, Dentali F, Akl EA, Cook DJ, Balekian AA, Klein RC, Le H, Schulman S, Murad MH. Prevention of VTE in nonsurgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141:e195S-e226S. [PMID: 22315261 PMCID: PMC3278052 DOI: 10.1378/chest.11-2296] [Citation(s) in RCA: 1071] [Impact Index Per Article: 89.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2011] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND This guideline addressed VTE prevention in hospitalized medical patients, outpatients with cancer, the chronically immobilized, long-distance travelers, and those with asymptomatic thrombophilia. METHODS This guideline follows methods described in Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines in this supplement. RESULTS For acutely ill hospitalized medical patients at increased risk of thrombosis, we recommend anticoagulant thromboprophylaxis with low-molecular-weight heparin (LMWH), low-dose unfractionated heparin (LDUH) bid, LDUH tid, or fondaparinux (Grade 1B) and suggest against extending the duration of thromboprophylaxis beyond the period of patient immobilization or acute hospital stay (Grade 2B). For acutely ill hospitalized medical patients at low risk of thrombosis, we recommend against the use of pharmacologic prophylaxis or mechanical prophylaxis (Grade 1B). For acutely ill hospitalized medical patients at increased risk of thrombosis who are bleeding or are at high risk for major bleeding, we suggest mechanical thromboprophylaxis with graduated compression stockings (GCS) (Grade 2C) or intermittent pneumatic compression (IPC) (Grade 2C). For critically ill patients, we suggest using LMWH or LDUH thromboprophylaxis (Grade 2C). For critically ill patients who are bleeding or are at high risk for major bleeding, we suggest mechanical thromboprophylaxis with GCS and/or IPC at least until the bleeding risk decreases (Grade 2C). In outpatients with cancer who have no additional risk factors for VTE we suggest against routine prophylaxis with LMWH or LDUH (Grade 2B) and recommend against the prophylactic use of vitamin K antagonists (Grade 1B). CONCLUSIONS Decisions regarding prophylaxis in nonsurgical patients should be made after consideration of risk factors for both thrombosis and bleeding, clinical context, and patients' values and preferences.
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Affiliation(s)
- Susan R Kahn
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Wendy Lim
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Andrew S Dunn
- Department of Medicine, Mount Sinai School of Medicine, New York, NY
| | - Mary Cushman
- Department of Medicine, University of Vermont and Fletcher Allen Health Care, Burlington, VT
| | - Francesco Dentali
- Department of Clinical Medicine, University of Insubria, Varese, Italy
| | - Elie A Akl
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada; Department of Medicine, University at Buffalo, Buffalo, NY
| | - Deborah J Cook
- Department of Medicine, McMaster University, Hamilton, ON, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Alex A Balekian
- Division of Pulmonary and Critical Care Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Russell C Klein
- Huntington Beach Internal Medicine Group, Newport Beach, CA; Department of Pulmonary and Critical Care Medicine, University of California Irvine School of Medicine, Orange, CA
| | - Hoang Le
- Hoag Memorial Hospital Presbyterian, Newport Beach, CA; Pulmonary Division, Fountain Valley Regional Hospital, Fountain Valley, CA
| | - Sam Schulman
- Division of Hematology and Thromboembolism, McMaster University, Hamilton, ON, Canada
| | - M Hassan Murad
- Division of Preventive Medicine and the Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN.
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Risk of venous thromboembolism in patients nursed at home or in long-term care residential facilities. Int J Vasc Med 2011; 2011:305027. [PMID: 21748017 PMCID: PMC3124858 DOI: 10.1155/2011/305027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2011] [Accepted: 03/31/2011] [Indexed: 11/23/2022] Open
Abstract
Background. This study investigated the prevalence of and impact of risk factors for deep venous thrombosis (DVT) in patients with chronic diseases, bedridden or with greatly limited mobility, cared for at home or in long-term residential facilities. Methods. We enrolled 221 chronically ill patients, all over 18 years old, markedly or totally immobile, at home or in long-term care facilities. They were screened at the bedside by simplified compression ultrasound. Results. The prevalence of asymptomatic proximal DVT was 18% (95% CI 13–24%); there were no cases of symptomatic DVT or pulmonary embolism. The best model with at most four risk factors included: previous VTE, time of onset of reduced mobility, long-term residential care as opposed to home care and causes of reduced mobility. The risk of DVT for patients with reduced mobility due to cognitive impairment was about half that of patients with cognitive impairment/dementia. Conclusions. This is a first estimate of the prevalence of DVT among bedridden or low-mobility patients. Some of the risk factors that came to light, such as home care as opposed to long-term residential care and cognitive deficit as causes of reduced mobility, are not among those usually observed in acutely ill patients.
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Engbers MJ, van Hylckama Vlieg A, Rosendaal FR. Venous thrombosis in the elderly: incidence, risk factors and risk groups. J Thromb Haemost 2010; 8:2105-12. [PMID: 20629943 DOI: 10.1111/j.1538-7836.2010.03986.x] [Citation(s) in RCA: 193] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The incidence of venous thrombosis (VT) increases sharply with age: it is very rare in young individuals (<1 per 10,000 per year) but increases to ∼ 1% per year in the elderly, which indicates that aging is one of the strongest and most prevalent risk factor for venous thrombosis. The cause of this steep age gradient is as yet, unexplained. The aim of this review was to provide an overview of studies on the effect of conventional risk factors as well as age-specific risk factors for thrombosis in the elderly. Limited data are available on risk factors for thrombosis in the elderly, i.e. all results are based on small study groups. Results indicate that, of the conventional risk factors, malignant disease, the presence of co-morbidities and the genetic risk factors factor (F)V Leiden and the prothrombin mutation seem to be associated with an increased risk of venous thrombosis. In the elderly, the population attributable risk (PAR) of malignancy is approximately 35%, for co-morbidities a PAR up to 25% is found, and the contribution of genetic risk factors to the thrombosis incidence is estimated to be 7-22%. Age-specific risk factors of thrombosis, i.e. endothelial dysfunction and frailty may be important in the explanation of the increased incidence of VT in the elderly. In conclusion, as aging is a major risk factor for thrombosis, further identification of the risk factors for thrombosis in the elderly is needed to elucidate the age gradient of the incidence of VT and to target preventive measures.
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Affiliation(s)
- M J Engbers
- Department of Clinical Epidemiology, Leiden University Medical Center, the Netherlands
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Rodríguez-Mañas L, Gómez-Huelgas R, Veiga-Fernández F, Ruiz GM, González JM. Thromboprophylaxis with the Low-Molecular-Weight Heparin Bemiparin Sodium in Elderly Medical Patients in Usual Clinical Practice. Clin Drug Investig 2010; 30:337-45. [DOI: 10.2165/11535460-000000000-00000] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Zarowitz BJ, Tangalos E, Lefkovitz A, Bussey H, Deitelzweig S, Nutescu E, O'Shea T, Resnick B, Wheeler A. Thrombotic Risk and Immobility in Residents of Long-Term Care Facilities. J Am Med Dir Assoc 2010; 11:211-21. [DOI: 10.1016/j.jamda.2009.11.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Revised: 11/15/2009] [Accepted: 11/16/2009] [Indexed: 10/19/2022]
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Haas S, Spyropoulos AC. Primary Prevention of Venous Thromboembolism in Long-Term Care: Identifying and Managing the Risk. Clin Appl Thromb Hemost 2008; 14:149-58. [DOI: 10.1177/1076029607311779] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Venous thromboembolism (VTE) is a significant, but underestimated, cause of morbidity and mortality in long-term care settings. VTE risk increases significantly with age and is further increased by comorbidities common to this group; however, advancing age and limited mobility alone are insufficient to warrant pharmacological prophylaxis. Recognizing those at increased VTE risk during an acute illness is crucial for appropriate and timely prophylaxis. Warfarin is used for the long-term secondary prevention of VTE, whereas unfractionated and low-molecular-weight heparins are used for primary prophylaxis. The elderly are at increased risk for bleeding complications, because of the high frequency of comorbidities and comedications. Attention to dosing is recommended for those with severely impaired renal function, low body weight, or perceived to be at high bleeding risk. This review addresses the role of risk assessment in the decision of when to provide prophylaxis to an individual in long-term care and highlights key management issues for those prescribed prophylaxis.
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Affiliation(s)
- Sylvia Haas
- Institut für Experimentelle Onkologie und Therapieforschung, Universität Munchen, Munich, Germany,
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Del Rio RA, Goldman M, Kapella BK, Sulit L, Murray PK. The accuracy of Minimum Data Set diagnoses in describing recent hospitalization at acute care facilities. J Am Med Dir Assoc 2006; 7:212-8. [PMID: 16698506 DOI: 10.1016/j.jamda.2005.12.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The Minimum Data Set (MDS) is the resident assessment instrument used to guide clinical care, reimbursement, and assess quality in long-term care facilities. This database has been used in many studies, although the accuracy of many data elements remains unknown. This study evaluated the accuracy of the MDS diagnosis variables with respect to the diagnoses for recent hospitalization from Medicare claims data. DESIGN Retrospective cohort study. SETTING 945 skilled nursing facilities in Ohio. PARTICIPANTS 17,294 residents admitted from an acute care facility during 2000. MEASUREMENTS Eleven diagnoses listed in the MDS were compared with Medicare hospital discharge claims. Specifically, each MDS diagnosis was compared to the primary diagnosis, the list of secondary diagnoses, and the Diagnosis Related Group (DRG). RESULTS Claims diagnoses were listed in the MDS with an average frequency of 79% (range: 31%-94%) for the primary diagnosis, 66% (range: 33%-90%) for any diagnosis, and 71% (range: 31%-94%) for the DRG. MDS diagnoses were listed as the primary diagnosis, any diagnosis, and DRG with an average frequency of 20% (range: 6%-81%), 62% (range: 41%-86%), and 19% (range: 7%-84%), respectively, with only hip fracture listed more than 80% of the time. CONCLUSION The sensitivity of the MDS for listing diagnoses from recent hospitalization appears good for most diagnoses. However, except for hip fracture, the MDS has poor predictive value with regard to the primary reason for the preceding hospitalization; this may have implications for resident care planning and the utility of this database in long-term care research.
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Affiliation(s)
- Richard A Del Rio
- Division of Gastroenterology, University Hospitals of Cleveland/Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA.
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