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Pulmonary Vascular Disease |

Comparison of Venous Thromboembolism Risk-Assessment Tools for Medical Patients: Padua Score vs Brazilian Guideline Algorithm FREE TO VIEW

Ana Thereza Rocha, MD; Edison Paiva, MD; Eduardo Emmanoel
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Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil


Chest. 2014;146(4_MeetingAbstracts):825A. doi:10.1378/chest.1991277
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Abstract

SESSION TITLE: DVT/PE/Pulmonary Hypertension Posters I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: The ENDORSE showed that 42% of hospitalized medical patients around the world were at-risk for venous thromboembolism (VTE) and prophylaxis was omitted in 60%. In Brazil, 46% and 59%, respectively. The evaluation of VTE risk was based on the 2004 ACCP guidelines, which were somewhat narrow and did not include a risk-assessment tool. The Brazilian Guideline (BG) for VTE prophylaxis (2006) promotes an algorithm (figure 1), available at the profilaxiadetev.org, an on-line registry of risk-assessment for Brazilian hospitals initiating VTE prophylaxis programs. The 2012 ACCP guidelines suggest the use of Padua Score (PS) for VTE risk-assessment (table 1). We evaluated the VTE risk of medical patients at the profilaxiadetev.org registry and compared the assessment using the BG algorithm and the PS.

METHODS: We evaluated data from cross sectional audits in 113 participating hospitals from 6/2008 till 2/2014. Data on VTE and bleeding risk factors (RF), and use of prophylaxis are entered by local hospitals. Percentages were compared with chi-square test and age with T-test.

RESULTS: A total of 66,221 patients were registered; 49,2% were medical and 25,889 had complete variables for the analysis. Excluded cases were ≤ 18y/o or had missing age. According to the BG, 53,1% of medical patients were at-risk and 52,1% had PS ≥ 4 (high risk). The PS evaluates 11 variables; all but one (trauma or surgery performed ≤ 1 month) are also included in the BG algorithm. The mean age for at-risk patients was higher 74±13 and 72±16 vs. 52±20 and 52±18 (p=0,0001) by BG and PG, respectively. The most frequent RF were age >55 years (68,1%), immobility (60,7%), infection (24,8%), respiratory failure (9,6%), CVA (9,1%), cancer (8,8%), heart failure (6,8%), MI (6,0%), previous VTE (5,3%) and obesity (4,9%). There were 9,8% of discordant cases. Age >55, infection and obesity led to similar classification, while all the other variables were more common in patients at-risk by PS vs. BG (p=0,0001 for all). Reduced mobility was present in 100% of patients at-risk by the BG and in 96% by PS.

CONCLUSIONS: More than half of hospitalized medical patients are at-risk for VTE. The BG offers an easy-to-use algorithm for risk-assessment without the need for score calculation. Although there is some variability, the BG performs similarly to the PS, agreeing in 90,2% of the cases.

CLINICAL IMPLICATIONS: The evaluation of VTE risk is paramount for the adequacy of prophylaxis. The BG algorithm offers a valid alternative for risk-assessment in medical patients.

DISCLOSURE: Ana Thereza Rocha: Consultant fee, speaker bureau, advisory committee, etc.: Consultant, Consultant fee, speaker bureau, advisory committee, etc.: Speaker Edison Paiva: Consultant fee, speaker bureau, advisory committee, etc.: Consultant, Consultant fee, speaker bureau, advisory committee, etc.: Speaker Eduardo Emmanoel: Consultant fee, speaker bureau, advisory committee, etc.: Consultant, Consultant fee, speaker bureau, advisory committee, etc.: Speaker

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