Low Rate of Intrahospital Deep Venous Thrombosis in Acutely Ill Medical Patients: Results From the AURELIO Study |
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| Authors: | Lorenzo Loffredo Vincenzo Arienti Gianpaolo Vidili Chiara Cogliati Simona Battaglia Ludovica Perri Rosella Di Giulio Sciaila Bernardini Maria Luna Summa Angela Sciacqua Francesco Perticone Maria Boddi Giovanni Di Minno Corrado Lodigiani Antonello Pietrangelo Alessio Farcomeni Francesco Violi |
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| Institution: | 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 |
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| Abstract: | ObjectiveTo 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.MethodsThe 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.ResultsAmong 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.ConclusionWe 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. |
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| Keywords: | CUS compression ultrasonography DOAC direct oral anticoagulant DVT deep venous thrombosis LMWH low-molecular-weight heparin REPOSI REgistro POliterapie Societa` Italiana di Medicina Interna VTE venous thromboembolism |
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