Summary

Prophylaxis of venous thromboembolism in hospitalized patients admitted from Spanish emergency departments: the PROTESU II study

César Rincón Díaz1, Sònia Jiménez Hernández2, Fahd Beddar Chaib3,4, Ana Isabel Condon Abanto5, María Cortés Ayaso6, Laura Lozano Polo7, Leticia Guirado Torrecillas8, Héctor Alonso Valle9, Mónica Olid Velilla1, David Jiménez10-12, Ramón Lecumberri13,14, Pedro Ruiz Artacho1,12,15, en representación del Grupo de trabajo de Enfermedad Tromboembólica Venosa de la Sociedad Española de Medicina de Urgencias y Emergencias (ETV-SEMES)

Affiliation of the authors

1Departamento de Medicina Interna, Clínica Universidad de Navarra, Madrid, Spain. 2Área de Urgencias, Hospital Clinic, IDIBAPS, Barcelona, Spain. 3Servicio de Urgencias, Complejo Asistencial de Soria, Spain. 4Universidad de Valladolid, Facultad de Ciencias de la Salud, Valladolid, Spain. 5Servicio de Urgencias, Hospital Universitario Joan XXIII, Tarragona, Spain. 6Servicio de Urgencias, Hospital Clínico Universitario de Santiago, A Coruña, Spain.7Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. 8Servicio de Medicina Interna, Hospital Universitario Virgen La Arrixaca, Murcia, Spain. 9Servicio de Urgencias, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain. Grupo Salud Comunitaria del Instituto de Investigación Sanitaria Valdecilla (IDIVAL). 10Servicio de Neumología, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain. 11Departamento de Medicina, Universidad de Alcalá, Madrid, Spain. 12CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain. 13Servicio de Hematología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain. 14CIBER-CV, Madrid, Spain. 15Interdisciplinar Teragnosis and Radiosomics (INTRA) Research Group, Universidad de Navarra, Spain.

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Rincón Díaz C, Jiménez Hernández S, Beddar Chaib F, Condon Abanto AI, Cortés Ayaso M, Lozano Polo L, et al. Prophylaxis of venous thromboembolism in hospitalized patients admitted from Spanish emergency departments: the PROTESU II study. Emergencias. 2024;36:271-80

Summary

Objectives.

To estimate the prevalence of inappropriate use of prophylaxis to prevent venous thromboembolism (VTE) in patients with medical diseases admitted to hospital from the emergency department. To explore variables associated with inappropriate thromboprophylaxis.

Methods.

Prospective multicenter cohort study in 15 hospital emergency departments. We included patients admitted for a medical condition during 7 days in the first quarter of 2022. We assessed risk for VTE with the Padua Prediction Score (PPS). Inappropriate thromboprophylaxis was defined by failure to prescribe prophylaxis in patients with a high-risk PPS assessment unless there were absolute contraindications (active bleeding or severe thrombopenia) or, alternatively, the prescription of prophylaxis in patients with a low-risk PPS assessment or absolute contraindications. A logistic regression model was adjusted for risk level to identify variables associated with inappropriate use of thromboprophylaxis.

Results.

Of a total of 630 patients included, 450 (71.4%) had PPS scores indicating high risk for VTE; 180 patients were at low risk. Thromboprophylaxis was inappropriate in 248 patients (39.4%): 165 high-risk patients who received no prophylaxis, 82 low-risk patients who were nonetheless treated, and 1 patient who was treated in spite of severe thrombopenia. Odds ratios (ORs) revealed that the variables associated with inappropriate use of thromboprophylaxis were trauma or recent surgery (OR, 5.53; 95% CI, 1.58-19.34), presence of factors indicating risk for bleeding (OR, 2.61; 95% CI, 1.44-4.73), and hospital admission for either urinary tract infection (OR, 2.29; 95% CI, 1.07-4.87) or gastrointestinal disease (OR, 4.30; 95% CI, 1.71-10.85).

Conclusions.

The inappropriate use of thromboprophylaxis in Spanish emergency departments is high and associated with certain clinical characteristics.

 

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