Francesco Dentali1, Fulvio Pomero2, Micaela La Regina3, Francesco Orlandini3, Sara Turato4, Antonino Mazzone5, Carlo Nozzoli6, Andrea Fontanella7, Walter Ageno4, Giancarlo Agnelli8, Mauro Campanini9. 1. Department of Clinical Medicine Insubria University, Varese, Italy. Electronic address: fdentali@libero.it. 2. Department of Clinical Medicine, ASO S. Croce e Carle, Cuneo, Italy. 3. Department of Internal Medicine, Presidio Ospedaliero Unico del Levante Ligure, La Spezia, Italy. 4. Department of Clinical Medicine Insubria University, Varese, Italy. 5. Department of Internal Medicine, A.O. Ospedale Civile, Legnano, Italy. 6. Department of Internal Medicine, A.O. Careggi, Firenze, Italy. 7. Department of Internal Medicine, Ospedale del Buon Consiglio, Napoli, Italy. 8. Internal and Cardiovascular Medicine and Stroke Unit, University of Perugia, Perugia, Italy. 9. Department of Internal Medicine, AOU Maggiore della Carità, Novara, Italy.
Abstract
AIMS: acutely ill medical patients are at increased risk of venous thromboembolism (VTE) and often require thromboprophylaxis, but patient selection and adequate therapeutic decisions may be difficult due to the heterogeneity and the complexity of this population. We conducted a survey among a large cohort of Italian physicians to assess their approach to some important "grey" areas of VTE prevention in this setting. METHODS: a questionnaire was distributed during the meeting of a national society of Internal Medicine (FADOI), held in May 2013. Four clinical scenarios describing areas of clinical uncertainty were administered to participants: the first on a patient with acute ischemic stroke; the second on a patient with severe renal insufficiency; the third on the duration of prophylaxis in the post-acute setting; and the last on a patient at high risk of VTE and at moderate risk of bleeding with preserved mobility. RESULTS: 453 questionnaires were returned (participants mean age 48.5 years). About 70% of participants systematically assess VTE and bleeding risk in their clinical practice, but a minority of them use risk assessment models. Prolonged prophylaxis in the post-acute setting was voted by more than eighty percent of participants; replies to the other three clinical scenarios were more heterogeneous with none of the options selected by more than 60% of participant. CONCLUSION: physicians approach to "grey" areas of antithrombotic prophylaxis in the medical setting is quite heterogeneous and sometimes partially in contrast to recent guidelines, reinforcing the need for educational programs and high quality studies in this setting.
AIMS: acutely ill medical patients are at increased risk of venous thromboembolism (VTE) and often require thromboprophylaxis, but patient selection and adequate therapeutic decisions may be difficult due to the heterogeneity and the complexity of this population. We conducted a survey among a large cohort of Italian physicians to assess their approach to some important "grey" areas of VTE prevention in this setting. METHODS: a questionnaire was distributed during the meeting of a national society of Internal Medicine (FADOI), held in May 2013. Four clinical scenarios describing areas of clinical uncertainty were administered to participants: the first on a patient with acute ischemic stroke; the second on a patient with severe renal insufficiency; the third on the duration of prophylaxis in the post-acute setting; and the last on a patient at high risk of VTE and at moderate risk of bleeding with preserved mobility. RESULTS: 453 questionnaires were returned (participants mean age 48.5 years). About 70% of participants systematically assess VTE and bleeding risk in their clinical practice, but a minority of them use risk assessment models. Prolonged prophylaxis in the post-acute setting was voted by more than eighty percent of participants; replies to the other three clinical scenarios were more heterogeneous with none of the options selected by more than 60% of participant. CONCLUSION: physicians approach to "grey" areas of antithrombotic prophylaxis in the medical setting is quite heterogeneous and sometimes partially in contrast to recent guidelines, reinforcing the need for educational programs and high quality studies in this setting.
Authors: Marco Badinella Martini; Francesco Dentali; Andrea Pizzini; Fabrizio D'Ascenzo; Luigi Fenoglio; Fulvio Pomero Journal: Acta Biomed Date: 2020-03-19