1
|
A cross-sectional, multicenter, observational study to assess the prophylaxis of venous thromboembolism in Lebanese and Jordanian hospitals. Thromb J 2021; 19:9. [PMID: 33568129 PMCID: PMC7877011 DOI: 10.1186/s12959-021-00261-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 02/01/2021] [Indexed: 12/03/2022] Open
Abstract
Background There is a growing body of evidence showing substantial underuse of appropriate venous thromboembolism (VTE) prophylaxis in patients at risk. In the present study, our goal was to assess the current practices in the use rate of VTE prophylaxis among hospitalized patients in Jordan and Lebanon. Methods A cross-sectional, multicenter, observational study was conducted on 40 centers across Lebanon and Jordan. We included patients who were admitted to the participating hospitals for the treatment of a serious medical or surgical illness. The patients’ records were screened for the fulfillment of inclusion/exclusion criteria during a single assessment visit. The proportion of medical and surgical patients who were at risk of VTE and the thrombo-prophylactic measures employed by physicians for these patients were assessed according to the American College of Chest Physicians (ACCP 2016) guidelines. Results The present study included 704 patients (400 from Jordan and 304 from Lebanon) with a mean age of 54.9 ± 17.5 years. Almost 59% of the patients received prophylaxis treatment in form of pharmacological anticoagulant prophylaxis and/or mechanical prophylaxis. Low molecular weight heparin was the most commonly used anticoagulant for VTE prophylaxis in 366 out of the total 704 (51.9%) patients in the analysis cohort. Two hundred and sixteen patients (52, 95% confidence interval [47.1–56.9%]) received appropriate prophylactic agents out of 415 patients who were eligible for prophylaxis according to the ACCP 2016 guidelines. On the other hand, 199 (72.1, 95% confidence interval [66.4–77.3%) patients received prophylaxis out of 276 ineligible patients. The rate of compliance to guidelines showed wide variations according to the type of hospital, specialty, and the patients’ age. The multivariate logistic regression analysis showed that only age was a significant predictor of appropriate VTE prophylaxis (odds ratio [OR] 1.05, P < 0.001). Conclusion The rates of the appropriate use of VTE prophylaxis are low in Lebanon and Jordan. There is a lack of compliance to guidelines for VTE prophylaxis use for hospitalized patients in both countries. Supplementary Information The online version contains supplementary material available at 10.1186/s12959-021-00261-2.
Collapse
|
2
|
Abstract
Given the broad treatment options, risk stratification of pulmonary embolism is a highly desirable component of management. The ideal tool identifies patients at risk of death from the original or recurrent pulmonary embolism. Using all-cause death in the first 30-days after pulmonary embolism diagnosis as a surrogate, clinical parameters, biomarkers, and radiologic evidence of right ventricular dysfunction and strain are predictive. However, no study has demonstrated improved mortality rates after implementation of a risk stratification strategy to guide treatment. Further research should use better methodology to study prognosis and test new management strategies in patients at high risk for death.
Collapse
Affiliation(s)
- Thomas Moumneh
- Department of Emergency Medicine, University Hospital of Angers, 4 rue Larrey, 49100 Angers, France; MITOVASC Institute, UMR CNRS 6015 UMR INSERM 1083, Angers University, 28, rue Roger-Amsler, 49045 Angers, France; University of Ottawa, 451 Smyth Road, Ottawa, Ontario, Canada
| | - Philip S Wells
- Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, 501 Smyth Road, Suite M1857, PO Box 206, Ottawa, Ontario K1H 8L6, Canada.
| | - Sebastien Miranda
- University of Ottawa, 451 Smyth Road, Ottawa, Ontario, Canada; Department of Internal Medicine, Vascular and Thrombosis Unit, Rouen University Hospital, 37 Boulevard Gambetta, 76000 Rouen, France; Normandie University, UNIROUEN, INSERM U1096, 22 Boulevard Gambetta, 76000 Rouen, France
| |
Collapse
|
3
|
Moumneh T, Riou J, Douillet D, Henni S, Mottier D, Tritschler T, Le Gal G, Roy PM. Validation of risk assessment models predicting venous thromboembolism in acutely ill medical inpatients: A cohort study. J Thromb Haemost 2020; 18:1398-1407. [PMID: 32168402 DOI: 10.1111/jth.14796] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 03/06/2020] [Accepted: 03/09/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Because hospital-acquired venous thromboembolism (VTE) represents a frequent cause of preventable deaths in medical inpatients, identifying at-risk patients requiring thromboprophylaxis is critical. We aimed to externally assess the Caprini, IMPROVE, and Padua VTE risk scores and to compare their performance to advanced age as a stand-alone predictor. METHODS We performed a retrospective analysis of patients prospectively enrolled in the PREVENU trial. Patients aged 40 years and older, hospitalized for at least 2 days on a medical ward were consecutively enrolled and followed for 3 months. Critical ill patients were not recruited. Patients diagnosed with VTE within 48 hours from admission, or receiving full dose anticoagulant treatment or who underwent surgery were excluded. All suspected VTE and deaths occurring during the 3-month follow-up were adjudicated by an independent committee. The three scores were retrospectively assessed. Body mass index, needed for the Padua and Caprini scores, was missing in 44% of patients. RESULTS Among 14 910 eligible patients, 14 660 were evaluable, of which 1.8% experienced symptomatic VTE or sudden unexplained death during the 3-month follow-up. The area under the receiver operating characteristic curves (AUC) were 0.60 (95% confidence interval [CI] 0.57-0.63), 0.63 (95% CI 0.60-0.66) and 0.64 (95% CI 0.61-0.67) for Caprini, IMPROVE, and Padua scores, respectively. None of these scores performed significantly better than advanced age as a single predictor (AUC 0.61, 95% CI 0.58-0.64). CONCLUSION In our study, Caprini, IMPROVE, and Padua VTE risk scores have poor discriminative ability to identify not critically ill medical inpatients at risk of VTE, and do not perform better than a risk evaluation based on patient's age alone.
Collapse
Affiliation(s)
- Thomas Moumneh
- Département de Médecine d'Urgence, CHU d'Angers, Institut MITOVASC, UMR CNRS 6015, UMR INSERM 1083, InnoVTE F-CRIN, Université d'Angers, Angers, France
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Jérémie Riou
- Unité de Formation-Recherche Santé, MINT UMR INSERM 1066, CNRS 6021, Université d'Angers, Angers, France
| | - Delphine Douillet
- Département de Médecine d'Urgence, CHU d'Angers, Institut MITOVASC, UMR CNRS 6015, UMR INSERM 1083, InnoVTE F-CRIN, Université d'Angers, Angers, France
| | - Samir Henni
- Service des explorations fonctionnelles vasculaires, CHU d'Angers, Institut MITOVASC, UMR CNRS 6015, UMR INSERM 1083, Université d'Angers, Angers, France
| | - Dominique Mottier
- Département de Médecine Interne et Pneumologie, CHU de la Cavale Blanche, EA3878 (GETBO), CIC INSERM 1412, InnoVTE F-CRIN, Université de Bretagne Occidentale, Brest, France
| | - Tobias Tritschler
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Grégoire Le Gal
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Pierre-Marie Roy
- Département de Médecine d'Urgence, CHU d'Angers, Institut MITOVASC, UMR CNRS 6015, UMR INSERM 1083, InnoVTE F-CRIN, Université d'Angers, Angers, France
| |
Collapse
|
4
|
Ishikawa M, Tanino MA, Miyazaki M, Kimura T, Ishida Y, Wang L, Tsuda M, Nishihara H, Nagashima K, Tanaka S. A Clinicopathological Analysis of Six Autopsy Cases of Sudden Unexpected Death due to Infectious Aortitis in Patients with Aortic Tears. Intern Med 2018; 57:1375-1380. [PMID: 29321404 PMCID: PMC5995715 DOI: 10.2169/internalmedicine.8976-17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Objective Cardiovascular disease is a leading cause of sudden unexpected death even in hospitalized patients. Infectious aortitis is a rare disease that has the potential to cause aortic tears and hemorrhage followed by sudden death. The aim of this study was to reveal the clinicopathological features of infectious aortitis that are related to sudden unexpected death. Methods We retrospectively reviewed 1,310 autopsy cases over 15 years and selected the cases involving patients who died suddenly due to aortic tears. We analyzed the clinical information and pathological findings. Results One hundred thirty-three of 1,310 cases (10.2%) were autopsied under the clinical diagnosis of unexpected sudden death. Aortic tears were identified in 33 cases (2.5%) and infectious aortitis was diagnosed in 6 (18.2%) of these cases. All cases involved male patients (middle-aged to elderly) with risk factors for atherosclerosis (i.e., hypertension). The laboratory data showed continuous leukocytosis and C-reactive protein elevation, even during the improvement phase, in patients with pre-existing infectious disease. The autopsy findings revealed three types of aortic tears (aneurysms, dissections and penetrating atherosclerotic ulcers with moderate to severe atherosclerosis), and the infiltration of numerous neutrophils at the site of rupture. Gram-positive bacteria were detected in four cases and Gram-negative bacteria were detected in two cases. Discussion We demonstrated that sudden unexpected death caused by infectious aortitis rarely occurred in hospitalized patients, even in the recovery phase of the preceding infectious disease. We therefore recommend that clinicians pay attention to infectious aortitis in patients with infectious disease, particularly elderly patients with atherosclerotic disease, even those who are in the improvement phase. Conclusion Unexpected sudden death by infectious aortitis in the recovery phase of antecedent infection.
Collapse
Affiliation(s)
- Marin Ishikawa
- Department of Cancer Pathology, Hokkaido University Graduate School of Medicine, Japan
| | - Mishie Ann Tanino
- Department of Cancer Pathology, Hokkaido University Graduate School of Medicine, Japan
| | - Masaya Miyazaki
- Department of Renal and Genitourinary surgery, Hokkaido University Graduate School of Medicine, Japan
| | - Taichi Kimura
- Department of Cancer Pathology, Hokkaido University Graduate School of Medicine, Japan
| | - Yusuke Ishida
- Department of Cancer Pathology, Hokkaido University Graduate School of Medicine, Japan
| | - Lei Wang
- Department of Cancer Pathology, Hokkaido University Graduate School of Medicine, Japan
| | - Masumi Tsuda
- Department of Cancer Pathology, Hokkaido University Graduate School of Medicine, Japan
| | - Hiroshi Nishihara
- Department of Translational Pathology, Hokkaido University Graduate School of Medicine, Japan
| | - Kazuo Nagashima
- Department of Diagnostic Pathology, Sapporo Higashi Tokushukai Hospital, Japan
| | - Shinya Tanaka
- Department of Cancer Pathology, Hokkaido University Graduate School of Medicine, Japan
- Department of Translational Pathology, Hokkaido University Graduate School of Medicine, Japan
| |
Collapse
|
5
|
Granziera S, Cohen AT. VTE primary prevention, including hospitalised medical and orthopaedic surgical patients. Thromb Haemost 2017; 113:1216-23. [DOI: 10.1160/th14-10-0823] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 02/23/2015] [Indexed: 11/05/2022]
Abstract
summaryPrimary prevention is the key to managing a significant proportion of the burden of venous thromboembolism (VTE), defined as deep venous thrombosis (DVT) or pulmonary embolism (PE). This is because VTE may lead to sudden death or are often misdiagnosed and therefore treatment is not feasible. Primary prevention usually commences in hospital as VTE following hospitalisation adds to the significant disease burden worldwide. Numerous medical, surgical and other risk factors have been recognised and studied as indications for prophylaxis. The risk of VTE continues following admission to hospital with a medical or surgical condition, usually long after discharge and therefore prolonged primary prophylaxis is often recommended. Clinical and observational studies in surgical patients show this risk extends for months and perhaps more than one year, for medical patients the risk extends for at least several weeks. For the specific groups of patients at higher risk of developing VTE primary prevention, either pharmaceutical or mechanical, is recommended. The aim of this review is to describe the population at risk, the main related risk factors and the approach to thromboprophylaxis in different populations.
Collapse
|
6
|
Val-Bernal JF. [The current role of autopsy in current clinical practice]. Med Clin (Barc) 2015; 145:313-6. [PMID: 25851915 DOI: 10.1016/j.medcli.2015.02.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 02/25/2015] [Accepted: 02/27/2015] [Indexed: 11/17/2022]
Affiliation(s)
- José Fernando Val-Bernal
- Unidad de Patología, Departamento de Ciencias Médicas y Quirúrgicas, Universidad de Cantabria, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, España.
| |
Collapse
|
7
|
Rubbo B, Fitzpatrick NK, Denaxas S, Daskalopoulou M, Yu N, Patel RS, Hemingway H. Use of electronic health records to ascertain, validate and phenotype acute myocardial infarction: A systematic review and recommendations. Int J Cardiol 2015; 187:705-11. [PMID: 25966015 DOI: 10.1016/j.ijcard.2015.03.075] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 02/16/2015] [Accepted: 03/03/2015] [Indexed: 01/13/2023]
Abstract
Electronic health records (EHRs) offer the opportunity to ascertain clinical outcomes at large scale and low cost, thus facilitating cohort studies, quality of care research and clinical trials. For acute myocardial infarction (AMI) the extent to which different EHR sources are accessible and accurate remains uncertain. Using MEDLINE and EMBASE we identified thirty three studies, reporting a total of 128658 patients, published between January 2000 and July 2014 that permitted assessment of the validity of AMI diagnosis drawn from EHR sources against a reference such as manual chart review. In contrast to clinical practice, only one study used EHR-derived markers of myocardial necrosis to identify possible AMI cases, none used electrocardiogram findings and one used symptoms in the form of free text combined with coded diagnosis. The remaining studies relied mostly on coded diagnosis. Thirty one studies reported positive predictive value (PPV)≥ 70% between AMI diagnosis from both secondary care and primary care EHRs and the reference. Among fifteen studies reporting EHR-derived AMI phenotypes, three cross-referenced ST-segment elevation AMI diagnosis (PPV range 71-100%), two non-ST-segment elevation AMI (PPV 91.0, 92.1%), three non-fatal AMI (PPV range 82-92.2%) and six fatal AMI (PPV range 64-91.7%). Clinical coding of EHR-derived AMI diagnosis in primary care and secondary care was found to be accurate in different clinical settings and for different phenotypes. However, markers of myocardial necrosis, ECG and symptoms, the cornerstones of a clinical diagnosis, are underutilised and remain a challenge to retrieve from EHRs.
Collapse
Affiliation(s)
- Bruna Rubbo
- Farr Institute of Health Informatics Research, University College London, UK.
| | | | - Spiros Denaxas
- Farr Institute of Health Informatics Research, University College London, UK
| | - Marina Daskalopoulou
- Department of Infection & Population Health, The Royal Free Hospital NHS Trust, London, UK
| | - Ning Yu
- Farr Institute of Health Informatics Research, University College London, UK
| | - Riyaz S Patel
- Farr Institute of Health Informatics Research, University College London, UK; The Heart Hospital, University College London NHS Trust, London, UK
| | | | - Harry Hemingway
- Farr Institute of Health Informatics Research, University College London, UK
| |
Collapse
|
8
|
Ifteni P, Correll CU, Burtea V, Kane JM, Manu P. Sudden unexpected death in schizophrenia: autopsy findings in psychiatric inpatients. Schizophr Res 2014; 155:72-6. [PMID: 24704220 DOI: 10.1016/j.schres.2014.03.011] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 03/07/2014] [Accepted: 03/12/2014] [Indexed: 12/16/2022]
Abstract
Schizophrenia is associated with premature mortality and a high rate of sudden, unexpected deaths. Autopsy data are scant, and in studies using death certificates or root cause assessments, a majority of sudden deaths remained unexplained. In the community, post-mortem data indicate that the most common cause of sudden "natural" death is coronary artery disease. In this study, we used autopsy findings to determine the cause of sudden death in a consecutive cohort of 7189 schizophrenia patients admitted to a free-standing, psychiatric teaching hospital from 1989 to 2013. Medical record review identified 57 patients (0.79%) who died suddenly and unexpectedly during hospitalization. Autopsies were performed in 51 (89.5%) patients (55.9±9.4years, male=56.9%). Autopsy-based causes of sudden death were most commonly cardiovascular disorders (62.8%). Specific causes included myocardial infarction (52.9%), pneumonia (11.8%), airway obstruction (7.8%), myocarditis (5.9%), and dilated cardiomyopathy, hemopericardium, pulmonary embolus, hemorrhagic stroke and brain tumor (2.0% each). The sudden death remained unexplained in 6 (11.8%) patients, 3 of whom had evidence of coronary arteriosclerosis on autopsy. Patients with and without myocardial infarction were similar regarding age, gender, smoking, body mass index and psychotropic treatment (p values≥0.10). In conclusion, sudden cardiac death occurs at a 0.8% rate in a psychiatric hospital, well above general population rates. Autopsy findings indicate that sudden death in schizophrenia is caused by structural cardiovascular, respiratory and neurological abnormalities, with most cases due to acute myocardial infarction. Early recognition and treatment of coronary artery disease must become a clinical priority for all adults with schizophrenia.
Collapse
Affiliation(s)
- Petru Ifteni
- Faculty of Medicine, Transilvania University, Brasov, Romania
| | - Christoph U Correll
- Zucker Hillside Hospital, Glen Oaks, NY, United States; Hofstra North Shore - LIJ School of Medicine, Hempstead, NY, United States; Albert Einstein College of Medicine, Bronx, NY, United States
| | - Victoria Burtea
- Faculty of Medicine, Transilvania University, Brasov, Romania
| | - John M Kane
- Zucker Hillside Hospital, Glen Oaks, NY, United States; Hofstra North Shore - LIJ School of Medicine, Hempstead, NY, United States; Albert Einstein College of Medicine, Bronx, NY, United States
| | - Peter Manu
- Zucker Hillside Hospital, Glen Oaks, NY, United States; Hofstra North Shore - LIJ School of Medicine, Hempstead, NY, United States; Albert Einstein College of Medicine, Bronx, NY, United States.
| |
Collapse
|
9
|
Shiraev TP, Omari A, Rushworth RL. Trends in pulmonary embolism morbidity and mortality in Australia. Thromb Res 2013; 132:19-25. [DOI: 10.1016/j.thromres.2013.04.032] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 04/15/2013] [Accepted: 04/29/2013] [Indexed: 11/16/2022]
|
10
|
Time trends in pulmonary embolism: A matter of age and gender. Thromb Res 2013; 132:6-7. [DOI: 10.1016/j.thromres.2013.05.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2013] [Revised: 05/11/2013] [Accepted: 05/31/2013] [Indexed: 11/19/2022]
|
11
|
Nichols L, Chew B. Causes of sudden unexpected death of adult hospital patients. J Hosp Med 2012; 7:706-8. [PMID: 23024055 DOI: 10.1002/jhm.1980] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 08/06/2012] [Accepted: 08/10/2012] [Indexed: 11/12/2022]
Abstract
The sudden unexpected death of a hospitalized patient is distressing to the family and the healthcare team. It is also common. Assessment of the causes without autopsy is frequently incorrect. To elucidate the causes of death, 175 cases of adult hospital patients in the University of Pittsburgh Medical Center Health System, who died suddenly and unexpectedly, were investigated with autopsies. The most common cause was judged to be a cardiac arrhythmia, in 58 (33%) of cases, presumptive in 46 cases, because only 12 of these patients were on cardiac monitoring. Of the arrhythmia patients, 36 (62%) had ≥75% coronary artery stenosis and 31 (53%) had histological evidence of myocardial infarction, with 15 (26%) of those with subacute or old myocardial infarction lacking a history of myocardial infarction. Hemorrhage was judged the cause of death in 38 (22%) of cases, including 31 (82%) with endogenous coagulopathy, anticoagulation, or antiplatelet therapy. Pulmonary thromboembolism was judged the cause of death in 27 (15%) of cases. Overall, hemorrhage deserves better appreciation as a cause of sudden unexpected death of hospitalized adults.
Collapse
Affiliation(s)
- Larry Nichols
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
| | | |
Collapse
|
12
|
Abstract
OBJECTIVE Radiologic studies are anatomic studies lacking the natural full-color, 3D, and microscopic-level examination of autopsies, suggesting that autopsies might be able to serve as quality control for radiology. MATERIALS AND METHODS Cases in which complete or near-complete autopsies were performed at a university hospital in 2008 were reviewed, and antemortem radiologic diagnoses were compared with corresponding autopsy findings. Discrepancies between antemortem radiologic diagnoses and autopsy findings were categorized. RESULTS For 729 of the 828 diagnoses reviewed in the study, the pathologic condition in question was thought to be present at the time that a radiologic study of the relevant anatomic region was performed. Of these 729 radiologic diagnoses, 201 (27.6%) were determined to be discrepant from the corresponding autopsy diagnoses (i.e., autopsy deemed correct), but many of these radiologic discrepancies were not of clinical significance. The radiologic error rate considers only the clinically relevant discrepancies categorized as "missed diagnosis" or "misinterpretation"; it was calculated to be 3.3%. Interestingly, 32 autopsy discrepancies (i.e., radiology deemed correct) were also identified in the study. CONCLUSION The results of this study suggest that even in 2008 patients sometimes died with undiagnosed or misdiagnosed diseases. Radiologic diagnoses discrepant from autopsy findings were consistently identified in this study and show that autopsies can help radiologists sharpen their skills in interpreting radiologic studies and can perhaps serve as quality control for radiology. The results also suggest that radiology can serve as quality control for autopsy.
Collapse
|
13
|
Abstract
Abstract
Venous thromboembolism is a significant cause of illness and death worldwide. Large bodies of evidence support the heightened risk status of hospitalized medical patients, and that prophylactic measures significantly reduce the risk of thrombosis, yet these patients often fail to receive adequate prophylactic therapy. This failure may be accounted for by a lack of awareness of the relevant indications, poorly designed implementation systems, and clinical concerns over the side effects of anticoagulant medications. This article briefly summarizes our understanding of the clinical factors relevant to the evaluation of venous thromboembolism risk in hospitalized medical patients. We describe our approach to the use of thromboprophylaxis, through which we aim to minimize the disease burden of this under-recognized and preventable pathology.
Collapse
|
14
|
Hagestuen P, Aase S. Organisering og nytteverdi av obduksjon. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2012; 132:152-4. [DOI: 10.4045/tidsskr.10.1393] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
|