Lorenzo Loffredo1, Vincenzo Arienti2, Gianpaolo Vidili3, Chiara Cogliati4, Simona Battaglia1, Ludovica Perri1, Rosella Di Giulio2, Sciaila Bernardini5, Maria Luna Summa5, Angela Sciacqua6, Francesco Perticone6, Maria Boddi7, Giovanni Di Minno8, Corrado Lodigiani9, Antonello Pietrangelo10, Alessio Farcomeni11, Francesco Violi12. 1. Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy. 2. Department of Internal Medicine, Internal Medicine Unit, Maggiore Hospital, Bologna, Italy. 3. Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy. 4. Department of Internal Medicine, L. Sacco Hospital, ASST-fbf-sacco, Milan, Italy. 5. Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric Sciences, Division of Gerontology, Sapienza University of Rome, Rome, Italy. 6. Department of Medical and Surgical Sciences, University Magna-Græcia of Catanzaro, Catanzaro, Italy. 7. Experimental and Clinical Department, University of Florence, Florence, Italy. 8. Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy. 9. Humanitas Research Hospital, Cardiovascular Department, Thrombosis and Haemorragic Diseases Center, Rozzano, Milan, Italy. 10. Department of Internal Medicine 2, University Hospital of Modena, Modena, Italy. 11. Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy. 12. Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy. Electronic address: francesco.violi@uniroma1.it.
Abstract
OBJECTIVE: To evaluate the effect of hospitalization on deep venous thrombosis (DVT) rate by the cumulative incidence of DVT in the proximal venous tract of the lower limbs at admission and discharge. METHODS: The AURELIO (rAte of venoUs thRombosis in acutEly iLl patIents hOspitalized in internal medicine wards) multicenter observational study was carried out in hospital-university internal medicine wards including consecutive acutely ill medical patients. Patients underwent compression ultrasonography (CUS) of proximal lower limb veins at admission and discharge. The occurrence of DVT was the primary end point of the study. RESULTS: Among 1340 patients, 26 (1.9%; 95% CI, 1.3%-2.8%) had asymptomatic DVT at admission and were excluded. During the follow-up, 144 patients were excluded because of hospitalization less than 5 days. The remaining 1170 patients underwent a CUS at discharge. Two hundred fifty (21%) underwent prophylaxis with parenteral anticoagulants; the remaining 920 (79%) were not treated with anticoagulants. The mean length of hospitalization was 13±8 days. Compared with patients without prophylaxis, those treated with parenteral anticoagulants had a higher incidence of active cancer, heart and respiratory failure, pneumonia, renal failure, previous venous thromboembolism, reduced mobility, and elderly age. During the hospital stay, 3 patients with a negative CUS at admission experienced DVT in the proximal tract (0.025%, rate of 1 per 5017 patient-days); 2 of them were in prophylaxis with parenteral anticoagulants. CONCLUSION: We provide evidence that in the real world acutely ill medical patients display more than 90% (1.9%) asymptomatic DVT at admission, whereas the intrahospital DVT occurrence is very low. This suggests a novel diagnostic workup and a careful reanalysis of anticoagulant prophylaxis.
OBJECTIVE: To evaluate the effect of hospitalization on deep venous thrombosis (DVT) rate by the cumulative incidence of DVT in the proximal venous tract of the lower limbs at admission and discharge. METHODS: The AURELIO (rAte of venoUs thRombosis in acutEly iLl patIents hOspitalized in internal medicine wards) multicenter observational study was carried out in hospital-university internal medicine wards including consecutive acutely ill medical patients. Patients underwent compression ultrasonography (CUS) of proximal lower limb veins at admission and discharge. The occurrence of DVT was the primary end point of the study. RESULTS: Among 1340 patients, 26 (1.9%; 95% CI, 1.3%-2.8%) had asymptomatic DVT at admission and were excluded. During the follow-up, 144 patients were excluded because of hospitalization less than 5 days. The remaining 1170 patients underwent a CUS at discharge. Two hundred fifty (21%) underwent prophylaxis with parenteral anticoagulants; the remaining 920 (79%) were not treated with anticoagulants. The mean length of hospitalization was 13±8 days. Compared with patients without prophylaxis, those treated with parenteral anticoagulants had a higher incidence of active cancer, heart and respiratory failure, pneumonia, renal failure, previous venous thromboembolism, reduced mobility, and elderly age. During the hospital stay, 3 patients with a negative CUS at admission experienced DVT in the proximal tract (0.025%, rate of 1 per 5017 patient-days); 2 of them were in prophylaxis with parenteral anticoagulants. CONCLUSION: We provide evidence that in the real world acutely ill medical patients display more than 90% (1.9%) asymptomatic DVT at admission, whereas the intrahospital DVT occurrence is very low. This suggests a novel diagnostic workup and a careful reanalysis of anticoagulant prophylaxis.
Authors: Fahad A S AlEidan; Reem K AlManea; Alyah T AlMoneef; Nada A Shalash; Norah A AlRajhi; Sarah F AlMousa; Abdulrahman Al Raizah; Khadega A Abuelgasim Journal: Int J Gen Med Date: 2022-09-28