Venous thromboembolic risk and thromboprophylaxis in acutely ill medical outpatients

Phlebologie ◽  
2006 ◽  
Vol 35 (06) ◽  
pp. 286-288
Author(s):  
V. Hach-Wunderle ◽  
F. H. Mader ◽  
W. D. Paar ◽  
S. K. Haas
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Family Physicians ◽  
Medical Illness ◽  
Thromboembolic Risk ◽  
Objective Risk ◽  
Subjective Risk ◽  
Venous Thromboembolic ◽  
Objective Score ◽  
Medical Outpatients

Summary215 German family physicians participated in a prospective registry to assess the venous thromboembolic risk in acutely ill medical outpatients. In 1247 patients who were visited at home due to an acute medical illness, the risk factors were documented using a standardised questionnaire. The doctors subjectively rated the patient’s risk on a scale ranging from 1 to 10 and the result was compared with an objective risk-score which had been previously developed for hospitalized patients and has been successfully used in these patients. The results showed a wide agreement of the subjective risk assessment and the objective score. The resulting consequence of an adequate thromboprophylaxis reflects a high awareness of venous thromboembolic risk among the physicians treating acutely ill medical outpatients.

scholarly journals POS0303 PREVENTION OF CHRONIC DISEASES DUE TO INFLAMMATION IN INFLAMMATORY ARTHRITIS: RESULTS OF A DELPHI PROCESS TO SELECT CARE RECOMMENDATIONS FOR AN ELECTRONIC MEDICAL RECORD (EMR) INTERVENTION

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 377.1-377
Author(s):  
I. Sheriff ◽  
A. Lima ◽  
O. Tseng ◽  
A. Aviña ◽  
M. Dawes ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Chronic Diseases ◽  
Inflammatory Arthritis ◽  
Family Physicians ◽  
Delphi Process ◽  
Lifestyle Modifications ◽  
Cvd Risk ◽  
Level Of Evidence ◽  
Bmd Testing

Background:Inflammatory arthritis (IA) predisposes patients to several chronic conditions including cardiovascular diseases (CVD), diabetes (DM), osteoporosis (OP) and infections, likely due to systemic effects of inflammation. Studies have found that patients with IA often receive suboptimal care for screening and managing these conditions.Objectives:This is the first phase of a study which will develop and pilot test automated EMR reminders for family physicians. The reminders will prompt family physicians to screen for and address risk factors for these conditions. We conducted a Delphi process to select care recommendations to be addressed by the EMR reminders.Methods:We conducted a review of current BC, Canadian and international guidelines for screening and addressing risk factors for CVD, DM, OP and infection. A list of 22 care recommendations, including their level of evidence and risks/benefits of implementation, was reviewed by a panel of six family physicians, three rheumatologists and three IA patients, in a three-round online modified Delphi process. Panelists rated each care recommendation, using 9-point scales, on 1) their clinical importance, 2) their likelihood of improving outcomes, and 3) implementation feasibility. Results were discussed in an online forum. Panelists then rated slightly revised care recommendations, modified based on feedback from the discussion. Care recommendations were retained if the median rating was ≥7 with no disagreement as defined by the RAND/UCLA Method handbook.Results:A list of 15 care recommendations was selected by the Delphi process for EMR integration, including recommendations that address CVD risk assessment (1), hypertension screening (1), DM screening (2), fracture risk assessment (1), BMD testing (1), osteoporosis prevention (1) and treatment (1) with bisphosphonates, preventing infections through immunization (2), minimizing steroids (1) and hepatitis screening (1), screening for hydroxychloroquine retinal toxicity (1), and counselling for lifestyle modifications (2). We excluded 7 recommendations which addressed lipid testing (1), BMD testing in steroid users (1), immunizations (2), weight management (1), and DMARD laboratory test monitoring (2). Recommendations were excluded on the basis of importance (1) or feasibility (6).Conclusion:The results of the Delphi process will inform the development of reminders, integrated in EMRs, that will support family physicians in their efforts to engage IA patients in addressing risk factors for chronic diseases related to inflammation. We hope to improve the prevention of these diseases, which represent an important cause of morbidity and mortality for people with inflammatory arthritis.Acknowledgements:Iman Sheriff’s work on this project was funded by the CRA summer studentship programme. Dr. Lacaille is supported by the Mary Pack Chair in Arthritis Research from UBC and The Arthritis Society of Canada. Thank you to all who participated in the Delphi survey.Disclosure of Interests:None declared

scholarly journals Risk Assessing Medical Inpatients for Hospital-Acquired Venous Thrombosis: The Medical Inpatients Thrombosis and Hemostasis (MITH) Study

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 829-829
Author(s):  
Neil A. Zakai ◽  
Insu Koh ◽  
Katherine Wilkinson ◽  
Nicholas S Roetker ◽  
Andrew D Sparks ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Predictive Value ◽  
Chart Review ◽  
Distribution Width ◽  
Final Model ◽  
Objective Risk ◽  
Medical Inpatients ◽  
Hospital Acquired ◽  
Active Cancer

Abstract Introduction: Multiple regulatory agencies and professional societies recommend risk assessment of hospitalized medical patients for hospital-acquired (HA) venous thromboembolism (VTE) and provision of pharmacologic prophylaxis to those at risk. Extant risk assessment models (RAMs) include risk factors not knowable or difficult to assess at admission and often do not include risk factors reflecting illness acuity (such as laboratory studies and vital signs at admission). We developed a RAM for HA-VTE that reports absolute VTE risk, as opposed to arbitrary risk categories, using only objective risk factors measured within the first 24 hours of admission. Methods: The study setting was a combined academic and community 540-bed teaching hospital in northwest Vermont (The University of Vermont Medical Center). Using validated electronic health record (EHR) derived phenotypes (computable phenotypes), we captured all medical admissions between 2010-2019 and examined patient demographics, past medical history, and presenting vital and laboratory measures as potential risk factors for HA-VTE. As risk assessment should happen within 24 hours of admission, we only assessed risk factors knowable within this timeframe. Individuals with VTE at admission were excluded. Key outcome and risk factor definitions were validated using chart review. Bayesian logistic regression with a least absolute shrinkage and selection operator (LASSO) prior probability distribution was used to select risk factors for the model. Variables with a t-statistic ≥1.5 or ≤-1.5 were included in the final model. Full or prophylactic anticoagulation use was adjusted for in the final model. Model performance was assessed using bootstrap resampling to estimate area under the receiver operating characteristic (AUC) curve and calibration slope with 95% confidence interval (CI). Results: There were 62,468 medical admissions in the study period with 219 HA-VTE events. Chart review demonstrated the positive predictive value of our HA-VTE computable phenotype to be 84% and the negative predictive value 99%. Mean age was 65 years and 51% were male. Comorbid conditions were common in this hospitalized population, including active cancer (29%), congestive heart failure (25%), diabetes (27%), hypertension (59%), and prior myocardial infarction (13%). Seven risk factors met the criteria for inclusion in the final model: prior history of VTE (OR 2.7; 95% CI 1.8, 3.8), red cell distribution width ≥14.7% (OR 1.6; 95% CI 1.2, 2.2), creatinine ≥2.0 mg/dL or on dialysis (OR 2.0; 95% CI 1.4, 2.8), serum sodium <136 MEq/L (OR 1.5; 95% CI 1.1, 2.1), active cancer (OR 1.4; 95% CI 1.1, 2.0), malnutrition based on prior reported weight loss (OR 2.1; 95% CI 1.3, 3.3), and low hemoglobin (<13.6 g/dL in men, <12.1 g/dL in women; OR 1.5; 95% CI 1.0, 2.1). The unadjusted AUC of the RAM was 0.73 with an unadjusted calibration slope 1.09 (Figure 1). The optimism-adjusted AUC was 0.68 (95% CI 0.64, 0.71) and the optimism-adjusted calibration slope was 0.87 (95% CI: 0.72, 1.03). Discussion: We developed and internally validated a RAM for HA-VTE during medical hospitalization which incorporates simple, objective risk factors knowable within the first 24 hours of admission. Unlike most prior RAMs, this model also incorporates risk factors reflecting illness severity such as laboratory results. The RAM has good fit and calibration and will be moved forward to external validation. Future applications include incorporating the RAM into hospital admission workflows and assessing VTE prophylaxis rates and the incidence of HA-VTE and HA-bleeding. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

Abstract 13478: Pulmonary Embolism in Covid-19 Patients:A French Multicentre Cohort Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Charles Fauvel ◽  
Orianne Weizman ◽  
Antonin Trimaille ◽  
Delphine Mika ◽  
Nathalie Pace ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
Therapeutic Dose ◽  
Multivariable Analysis ◽  
Pulmonary Angiography ◽  
Univariable Analysis ◽  
Thromboembolic Risk ◽  
Reactive Protein ◽  
Hospitalised Patients ◽  
Venous Thromboembolic

Introduction: While pulmonary embolism(PE) appears to be a major issue in Covid-19, data remain sparse. Hypothesis: We aimed to describe the risk factors and baseline characteristics of patients with PE in a cohort of Covid-19 patients. Methods: In a retrospective multicentric observational study, we included consecutive hospitalised patients for Covid-19. Patients without computed tomography pulmonary angiography (CTPA)-proven PE diagnosis and those who were directly admitted to an intensive care unit(ICU) were excluded. Results: Among 1,240 patients (58.1% men, mean age 64±17 years), 103 (8.3%) patients had PE confirmed by CTPA. The ICU transfer and mechanical ventilation were significantly higher in the PE group (for both p<0.001). In an univariable analysis, traditional venous thromboembolic risk factors were not associated with PE (p>0.05), while patients under therapeutic-dose anticoagulation before hospitalisation or prophylaxis-dose anticoagulation introduced during hospitalisation had lower PE occurrence (OR 0.40, 95%CI(0.14-0.91); p=0.04 and OR 0.11, 95%CI(0.06-0.18); p<0.001, respectively). In a multivariable analysis, the following variables, also statistically significant in univariable analysis, were associated with PE: male gender (OR 1.03, 95%CI(1.003-1.069); p=0.04), anticoagulation with prophylaxis-dose (OR 0.83, 95%CI(0.79-0.85), p<0.001) or therapeutic-dose (OR 0.87, 95%CI(0.82-0.92), p<0.001), C-reactive protein (OR 1.03, 95%CI(1.01-1.04), p=0.001) and time from symptom onset to hospitalisation (OR 1.02, 95%CI(1.006-1.038), p=0.002). Conclusions: Pulmonary embolism risk factors in Covid-19 context do not include traditional thromboembolic risk factors but rather independent clinical and biological findings at admission, including a major contribution to inflammation.

Determining venous thromboembolic risk assessment for patients with trauma

2012 ◽  
Vol 73 (2) ◽  
pp. 511-515 ◽  
Author(s):  
Frederick B. Rogers ◽  
Steven R. Shackford ◽  
Michael A. Horst ◽  
Jo Ann Miller ◽  
Daniel Wu ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Thromboembolic Risk ◽  
Venous Thromboembolic

Venous thromboembolic risk assessment models should not solely guide prophylaxis and surveillance in trauma patients

2015 ◽  
Vol 79 (2) ◽  
pp. 194-198 ◽  
Author(s):  
Ashley L. Zander ◽  
Jan-Michael Van Gent ◽  
Erik J. Olson ◽  
Steven R. Shackford ◽  
Jayraan Badiee ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Trauma Patients ◽  
Thromboembolic Risk ◽  
Risk Assessment Models ◽  
Venous Thromboembolic

Screening for thromboembolic risk factors on IBD patients

2004 ◽  
Vol 42 (05) ◽  
Author(s):  
T Kristóf ◽  
G Nagy ◽  
I Vámosi ◽  
L Juhász
Keyword(s):  
Risk Factors ◽  
Thromboembolic Risk

Fall Risk Assessment and Risk Factors of Inpatients in Armed Forces Hospital

2016 ◽  
Vol 34 (1) ◽  
pp. 42-53
Author(s):  
Kyung-Wan Seo ◽  
Jeong-Ok Lee ◽  
Sun-Young Choi ◽  
Min-Jung Park
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Fall Risk ◽  
Armed Forces ◽  
Fall Risk Assessment

Diagnostic scales for suicide risk assessment

2020 ◽  
pp. 67-79
Author(s):  
L. Gelda ◽  
L. Nesterovich
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Medical Research ◽  
Suicide Risk ◽  
General Medicine ◽  
Diagnostic Tools ◽  
Suicide Risk Assessment ◽  
Research And Practice ◽  
Psychometric Instruments ◽  
High Incidence

The problem of adequate diagnostic tools use for suicide risk assessment т medical research and practice is of extreme importance because of the high incidence of suicide in the population of psychotic patients and the high vulnerability of the latter to the known risk factors. The article provides ап overview of the existing psychometric instruments (scales) used to assess the risk of suicide in psychiatry as well as in general medicine.

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