Association Between Hospitalization for Acute Medical Illness and VTE Risk: A Lower Efficacy of Thromboprophylaxis in Elderly Patients? Results from the Edith Case-Control Study
Notice bibliographique
Résumé
Abstract Background: Randomized controlled trials demonstrated that low-molecular-weight heparin (LMWH), unfractionated heparin (UFH), or fondaparinux, are efficient for venous thromboembolism (VTE) prevention in acutely ill medical patients. However, asymptomatic VTE, whose clinical relevance is unknown, represented the vast majority of outcome events of these trials. Objectives: Using a case-control design, we aimed to estimate the association between admission to hospital for acute medical illness, prescription of pharmacological thromboprophylaxis during admission and symptomatic VTE. Methods: 750 symptomatic non-surgical, non-cancer, and non-pregnancy-related VTE cases and their 750 age and sex-matched controls were analyzed. Patients hospitalized for an acute medical illness within three months prior to inclusion in the study were identified, and their hospital charts were reviewed. We considered that patients receiving pharmacological thromboprophylaxis were those prescribed either 1) LMWH at an approved preventive dose; 2) low dose UFH (5000 units bid or tid); or 3) fondaparinux 2.5mg once daily, for at least 6 days. Results: Patients' mean age was 67.2 ± 17.1 years, and 664 (44.3%) were men. A total of 145 cases (19.3%) and 91 controls (12.1%) were hospitalized for acute medical illness at least once in the preceding 3 months prior to inclusion in the study (p<0.001). Hospitalization for acute medical illness in the preceding three months was associated with a 75% increase in VTE risk: OR 1.75 (95% CI: 1.32-2.33). Pharmacological thromboprophylaxis was prescribed in 46.2% of the hospitalized cases (n=67) and in 51.6% of the controls (n=47) (p=0.49). As compared with patients who were not hospitalized, there was a significant 2-fold increased risk of VTE when thromboprophylaxis was not prescribed during hospitalization: OR 2.01 (95% CI: 1.22-3.29), and a non-significant 61% increased risk when thromboprophylaxis was prescribed during hospitalization: OR 1.61 (95% CI: 0.55-1.69). Proportions of admitted patients and prescription of pharmacological thromboprophylaxis are shown in table.Table 1.Age<75Age≥75CasesControlsOR (95% CI)CasesControlsOR (95% CI)No hospitalization365 (83.5%)380 (87.5%)Ref.240 (76.7%)279 (88.3%)Ref.Hospitalization for acute medical illness72 (16.5%)54 (12.5%)1.42 (0.96-2.08)73 (23.3%)37 (11.7%)2.25 (1.46-3.47)- No prescription of pharmacological thromboprophylaxis51 (70.8%)28 (51.9%)2.01 (1.11-3.62)27 (37.0%)16 (43.2%)2.02 (1.01-4.03)- Prescription of pharmacological thromboprophylaxis21 (29.2%)26 (48.1%)0.93 (0.44-1.95)46 (63.0%)21 (56.8%)2.69 (1.28-5.66) In patients <75 years, VTE risk associated with hospitalization for acute medical illness was low and not significant (OR 1.42 (95% CI: 0.96-2.08) as compared with no hospitalization. When pharmacological thromboprophylaxis was not prescribed during admission, there was a significant 2-fold increase in VTE risk associated with hospitalization: OR 2.01 (95% CI: 1.11-3.62), whereas no association was found when thromboprophylaxis was prescribed: OR 0.93 (95% CI: 0.44-1.95). In patients ≥75 years, we observed an overall 2.25-fold increase in VTE risk associated with hospitalization for acute medical illness as compared with no hospitalization: OR 2.25 (95% CI: 1.46-3.47). VTE risk associated with hospitalization remained significant whether or not pharmacological thromboprophylaxis was prescribed during hospitalization: OR 2.69 (95% CI 1.28-5.66) and OR 2.02 (95% CI: 1.01-4.03) respectively. Adjustment for a priori VTE risk stratification of medical hospitalized patients did not modify estimates. Conclusion: Our case-control study suggests that VTE prevention in acutely ill medical patients may be less effective in patients ≥75 years as compared with younger patients. This finding will be addressed in a randomized double blind controlled trial comparing enoxaparin 40mg once daily to placebo for the prevention of symptomatic VTE and fatal PE in patients ≥75 years admitted to hospital for an acute medical illness (NCT02379806). Disclosures No relevant conflicts of interest to declare.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,011 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».