Clinical Characteristics Of Hospital-associated Venous Thromboembolism

Objective This study investigated the epidemiological and clinical characteristics of hospital-associated venous thromboembolism(HA-VTE)in medical inpatients and surgical patients,as well as the effectiveness of HA-VTE prevention and treatment measures,and hoped to lay the foundation for gradually reducing the incidence of HA-VTE.Methods A total of 455 cases of HA-VTE were collected from January 2019 to December 2021 at Ningxia Medical University General Hospital.(1)To collect patient data,count the incidence of HA-VTE patients,and describe the trend of HA-VTE incidence;(2)To group patients into medical inpatients and surgical patients for statistical analysis of HA-VTE general characteristics,presence of definite venous thromboembolism(VTE)risk factors,primary disease and surgical site distribution;(3)divided medical inpatients into mild inpatients and severe inpatients,and analyzed their D-dimer and time of occurrence characteristics;(4)analyzed the time of occurrence characteristics of HA-VTE in surgical inpatients,and divided surgical patients into VTE intermediate risk group and VTE high risk group according to postoperative VTE score,and analyzed their D-dimer characteristics;(5)analyzed HA-VTE patients according to standard preventive measures,inadequate preventive measures and no measures were divided into 3groups,and the distribution of preventive measures taken before the occurrence of HA-VTE was counted;(6)HA-VTE patients treated with low-molecular heparin anticoagulation therapy were divided into low-molecular heparin sequential rivaroxaban group(observation group)and low-molecular heparin calcium anticoagulation therapy alone group(control group)according to whether the oral anticoagulant was adjusted at the subsequent discharge,and the statistics The number of defective pulmonary arteries as shown by CTPA and the presence of thrombosis on venous ultrasound of the lower extremities were followed for 3months,and the rates of complete thrombus absorption,partial thrombus absorption,no change,and increase in thrombus in the two treatment groups were compared.The results were statistically analyzed using SPSS 26.0 software,and P< 0.05 was considered a statistically significant difference.Results 1.136 cases of HA-VTE in 2019(1.1455‰),of which 54 cases of HA-PE(0.4548‰)and 82 cases of HA-DVT(0.6907‰);149 cases of HA-VTE in2020(1.4049‰),of which 55 cases of HA-PE(0.5186‰)and 94 cases of HA-DVT(0.8863‰).In 2021,there were 170 cases of HA-VTE(1.4648‰),including 85 cases of HA-PE(0.7324‰)and 85 cases of HA-DVT(0.7324‰).The incidence of hospital-associated VTE is on the rise.2.The differences in gender,age,and body mass index(BMI)of HA-VTE patients from 2019 to 2021 were not statistically significant,P > 0.05;the highest percentage of HA-VTE was in patients with DVT alone;there were more HA-VTE in surgical patients than in medical inpatients,P < 0.05,and the differences were statistically significant.3.86(19%)of medical inpatients had risk factors,17(4%)of patients without risk factors,and 352(77%)of surgical inpatients had risk factors,and the difference was statistically significant when the two groups were statistically analyzed,P < 0.05.4.The top three surgical procedures most prone to HA-VTE in surgical patients were orthopedic,abdominal and cranial;the more common comorbidities in medical inpatients were stroke in 49 cases(47.6%)and infection in 32 cases(31.1%),and the most prone to HA-VTE in medical inpatients were mostly distributed in neurology and medical patients in intensive care units.5.The time to occur of HA-VTE was 10.5(8.88-18.85)days for medical minor inpatients and 10.5(9.66-19.71)days for medical major inpatients,and the data were examined for the medical minor inpatient group and medical major inpatient group,and the results showed that the time to occur was not statistically significant for medical major inpatients,medical minor inpatients,P > 0.05;medical minor inpatients The time of HA-VTE in patients with minor medical conditions,patients hospitalized with severe medical conditions,and patients undergoing surgery showed an increasing trend in the first 14 days and peaked at8-14 days;the time of HA-VTE in patients undergoing surgery was counted and the highest number of cases occurred in the first 7 days after surgery.6.115 of 455 patients took standard prophylaxis,102 patients took prophylaxis but inadequate,and the remaining 238 patients did not take prophylaxis.7.The 3-month prognosis of 455 patients with HA-VTE was followed up,and274 patients were divided into 2 groups,in which the rates of complete thrombus absorption,partial thrombus absorption,no change,and increase in thrombus in the low-molecular heparin-only treatment group were 30.7%,30.3%,4.7%,and3.3%,respectively.The rates of complete thrombus absorption,partial thrombus absorption,no change,and thrombus increase in the low-molecular heparin sequential rivaroxaban treatment group were 15.0%,10.9%,2.2%,and 6.2%,respectively,P > 0.05,with no statistical difference.Conclusion 1.the incidence of HA-VTE has been on the rise in recent years.2.more HA-VTE secondary to neurological lesions in internal medicine and more HA-VTE secondary to orthopaedic surgery in surgery.3.more D-dimers in medical patients with severe disease than in patients with mild disease.4.medical HA-VTE occurs more often 8-14 days after admission and in surgical patients within 7 days after surgery.5.half of HA-VTE were not treated with VTE prophylaxis prior to its occurrence6.there was no difference in thrombus absorption between low-molecular heparin treatment alone and low-molecular heparin sequential rivaroxaban treatment.