ADECUACIÓN DE LA TROMBOPROFILAXIS EN PACIENTES QUE INGRESAN POR PATOLOGÍA MÉDICA DESDE LOS SERVICIOS DE URGENCIAS HOSPITALARIOS: ESTUDIO PROTESU.

RESUMEN OBJETIVO. Evaluar la adecuacion de la tromboprofilaxis en los pacientes medicos que ingresan desde los servicios de urgencias hospitalarios (SUH). METODOS. Estudio de cohortes prospectivo multicentrico , realizado en 6 SUH espanoles. Se incluyeron pacientes con patologia medica que requirieron ingreso hospitalario entre Diciembre 2011-Julio 2012. Se considero como variable de resultado primaria la adecuacion de tromboprofilaxis al ingreso desde el SUH, segun las recomendaciones de la guia PRETEMED. Las variables independientes fueron datos demograficos, comorbilidad, antecedentes patologicos personales, motivo de ingreso, factores de riesgo durante el ingreso y factores de riesgo hemorragico. RESULTADOS. Se incluyeron 610 pacientes, de los que 580 fueron evaluables (edad media 70,1±16,9, 45,3% mujeres). Segun PRETEMED, un 44,1% de los pacientes presentaron riesgo alto o moderado; de estos un 41,4 % no recibieron tromboprofilaxis al ingreso, requiriendola. Un 55,9% presentaron riesgo bajo y de ellos, un 29,6% recibieron tromboprofilaxis, sin requerirla. Hasta en un 34,8% se realizo tromboprofilaxis de forma inadecuada. Las variables que se asociaron a la no instauracion de tromboprofilaxis en los pacientes de riesgo moderado o alto fueron: existencia de alguna contraindicacion relativa por riesgo hemorragico (OR 15,00, IC 95% 4,61-48,67), ingreso desde primera visita frente unidad de corta estancia (OR 12,28, IC 95% 1,35-113,12), dependencia basal severa (OR 6,88, IC 95% 1,59-29,83), polimedicacion (OR 2,09, IC 95% 1,00-3,69), enfermedad hematologica (OR 4,32, IC 95% 0,85-21,83) e infeccion del tracto urinario (OR 2,39, IC 95% 0,90-6,37). La curva ROC del modelo alcanzo un area bajo la curva de 0,75 (0,69-0,81). CONCLUSION. Mas de una tercera parte de los pacientes recibieron tromboprofilaxis de forma inadecuada. Casi la mitad de los pacientes con indicacion de tromboprofilaxis, no la recibieron. La no instauracion de tromboprofilaxis se asocio a la existencia de algun factor de riesgo hemorragico, el ingreso desde primera visita, la dependencia severa, polimedicacion, infeccion urinaria y enfermedad hematologica. Palabras clave: tromboprofilaxis, servicios de urgencias hospitalarios, enfermedad tromboembolica venosa. ABSTRACT OBJECTIVE. To assess the adequacy of thromboprophylaxis in medical ill patients admitted from emergency department (ED). METHODS. Multicenter prospective cohort study conducted in 6 Spanish ED. Patients with medical conditions requiring hospital admission between December 2011-July 2012 were included. It was considered adequacy of thromboprophylaxis on admission from the ED as the primary outcome variable. Adequacy was evaluated as recommended by the PRETEMED guide. The independent variables were demographics, comorbidity, personal medical history, reason for admission, risk factors during hospitalization and bleeding risk factors. RESULTS. 610 patients were included, of whom 580 were evaluable (mean age 70.1 ± 16.9, 45.3% women). According PRETEMED, 44.1% of patients had high or moderate risk and of these 41.4 % not received thromboprophylaxis on admission requiring it. 55.9% of patients had low risk, 29.6% of them received thromboprophylaxis, not requiring it. Up to 34.8% received t hromboprophy alxis improperly. V ariables associated with no introduction of thromboprophylaxis in patients with moderate or high risk were: existence of a relative contraindication for bleeding risk (OR 15.00, 95% CI 4.61 to 48.67), admission from first check area against short stay unit (OR 12.28, 95% CI 1.35 to 113.12), severe basal status (OR 6.88, 95% CI 1.59 to 29.83), polypharmacy (OR 2 09 95% 1.00 to 3.69), hematologic disease (OR 4.32, 95% CI 0.85 to 21.83) and urinary tract infection (OR 2.39, 95% CI 0.90 -6.37). The ROC curve model achieved an area under the curve of 0.75 (0.69 to 0.81). CONCLUSION. More than a third of the patients received t hromboprophy alxis improperly. Almost half of patients requiring thromboprophylaxis, did not received it . I ntroduction of thromboprophylaxis is not associated with the existence of some factor of hemorrhagic risk, admission from first visit area , severe dependence, polypharmacy, urinary tract infection and hematologic disease. Keywords : thromboprophylaxis, emergency departments, venous thromboembolic disease.