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Emergency department use of thromboprophylaxis in patients not requiring admission: results from the URGENTV study

Jiménez Hernández S, Martínez Fernández S, Merlo Loranca M, Fernández Núñez JM, Ruiz Romero F, García Bermejo P

Sección de Urgencias Medicina, Área de Urgencias, Hospital Clínic, Barcelona. Grupo de Investigación Urgencias: Procesos y Patologías, Institut d��Investigacions Biomédiques Agustí Pi i Sunyer (IDIBAPS). Barcelona, Spain. Servicio de Urgenci

Objectives: To determine the number of patients at moderate to high risk for
thromboembolism who are discharged from hospital emergency departments without
appropriate treatment to prevent thrombosis. To analyze the factors associated with not
starting thromboprophylaxis.
Methods: This multicenter, retrospective, observational, epidemiologic study included
patients who came to a hospital emergency department with an acute medical emergency
or an exacerbation of a chronic disease and who did not require admission. The dependent
variable was failure to prescribe thromboprophylaxis on discharge. Independent variables
assessed were demographic characteristics, medical specialty, general medical history,
characteristics related to the emergency department visit, and foreseen mobility at
discharge. The PRETEMED scale to quantify the need for prophylaxis was used.
Results: We assessed a total of 2280 patients; 1850 (81.1%) were at moderate to high
risk. Of these, 42.1% were discharged without thromboprophylaxis. The variables
independently associated with not starting such treatment were bed rest not foreseen on
discharge (odds ratio [OR], 19.67; 95% confidence interval [CI], 13.83-27.99; P<.0005),
reduced mobility not foreseen on discharge (OR, 6.8; 95% CI, 5.2-8.9; P<.0005), history
of neurodegenerative disease (OR, 1.7; 95% CI, 1.2-2.5; P=.003), emergency
department stay longer than 12 hours (OR, 1.3; 95% CI, 1.1-1.8; P=.007), and advanced
age (OR, 1.03; 95% CI, 1.02-1.04; P<.005).
Conclusions: A large percentage of hospital emergency department patients at high to
moderate risk of thromboembolism are discharged without prophylaxis.

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