Evaluating The Use Of Anticoagulant Prophylaxis In Medically Ill Patients At High-risk For Venous Thromboembolism

Objective(s):To compare and analyze the current status of patients with high risks of VTE who receiving anticoagulant prophylaxis in different departments of internal medicine,whether it was to take appropriate preventive anticoagulant therapy and other existing problems,and through the use of comparative studies to explore whether prophylactic anticoagulant therapy is beneficial to patients with a high risk of concurrent VTE.Methods:This study retrospectively analyzed the various risk factors for concurrent VTE in 2017 in several internal medicine departments of the hospital,all hospitalized VTE high-risk populations should have received preventive anticoagulant therapy.Patients with age>40 years and length of hospital stay>3 days(1536 cases in total).Patients’ clinical data such as age,gender,BMI,risk factors for concurrent VTE,whether or not to receive prophylactic anticoagulant therapy,anticoagulation therapeutic regime,length of hospital stays,and hospitalization expenses were collected.By designing a case-control study,a comprehensive statistical analysis was conducted to determine the differences in mortality,treatment costs,and average length of hospital stay among high-risk groups of VTE patients who received and did not receive prophylactic anticoagulant therapy.Results:1.Among the 1,536 selected patients with high risk of developing VTE were scattered in several departments,of whom 643 were female(41.9%),893 were male(58.1%),376(24.5%)cases in Cardiovascular medicine,306 cases(19.9%)in Respiratory medicine,380 cases(24.7%)in Neurology,130 cases(8.5%)in EICU,119 cases(7.7%)in Hematology,120 cases(7.8%)in Gastroenterology,and 105 cases in Nephrology(6.8%).2.913 patients(59.4%)receiving anticoagulant prophylaxis,97.4%(889/913)of heparin anticoagulants(LMWH),vitamin K antagonists(Warfarin),thrombin inhibition(Dabigatran)and the factor Xa inhibitor(Fondaparinux)ratio were 1.8%(16/913),0.3%(3/913),and 0.5%(5/913),respectively.3.By designing a case-control study,it was found that there was no significant difference in the average lengths of hospital stay and mortality between the preventive anticoagulant therapy group and the untreated group(P>0.05).Compared the treatment group and the control group,the treatment group was higher in terms of hospitalization treatment costs and it was statistically significant(P<0.05).And the treatment group was divided into two groups:compared with early prevention(<48h)and later period prevention(>48h):the average length of stay and treatment costs for early prevention were lower than those after admission for 48 h which was statistically significant(P<0.05).There were no significant differences in the selection of prophylactic drugs between different departments,mainly use heparin anticoagulants(LMWH),but there were significant differences in the proportion of prophylactic anticoagulation.The ratio of anticoagulant prophylaxis were statistically high in Respiratory(97.7%)and Cardiology medicine(82.2%),which were followed by EICU(56.2%),Hematology(48.7%),Gastroenterology(48.3%),Nephrology(41%),and Neurology(19.2%).4.By studying the deaths of high-risk factors of VTE,the mortality rate of patients with respiratory failure who received preventive anticoagulant therapy was significantly lower than that of patients who did not receive anticoagulation(x2=12.998,P<0.001).The same situation also occurred in patients with AECOPD(x2=12.998,P<0.001).Conclusion(s):1.In our hospital,the chosen medically ill patients all have high risk factors for VTE,the total rate of anticoagulant prophylaxis was only 59.4%,the main anticoagulant prophylaxis regimen was heparin(97.4%),the proportion of anticoagulant therapy was uneven in different departments,with the highest proportion of anticoagulation in Respiratory medicine(97.7%)and cardiology(82.2%),and the lowest in Neurology(19.2%);2.Prophylactic anticoagulation therapy in high-risk groups of VTE starts in early stage(<48h),compared that of 48h after admission,which may shorten the length of hospital stay and reduce the cost of hospitalization.3.In the study of high risk factors for VTE in various medical departments,it was found that for patients with high risk factors like respiratory failure and AECOPD,prophylactic anticoagulant therapy can reduce mortality to a certain extent.