Abstract 3337

Introduction:

Risk assessment models (RAM) are helpful tools for the screening VTE risk in hospitalized patients. Most of the available RAMs have been constructed on a disease-based or surgery-based approach and include some of the most relevant risk factors for VTE. There is limited information on the impact and importance of individual and comorbidity related risk factors for VTE present during hospitalization on the global VTE risk. Incorporation of the most frequent VTE risk and bleeding risk factors related to comorbidities might improve the ability of RAM to detect real-life patients at risk VTE and to evaluate drawbacks for the application of thromboprophylaxis.

Aim of the study:

The primary aim of the COMPASS programme was to evaluate the prevalence of the all known VTE and bleeding risk factors reported in the literature in real-life surgical and medical hospitalized patients.

Methods:

A prospective multicenter cross-sectional observational study was conducted in 6 hospitals in Greece and 1 in France. All inpatients aged >40 years hospitalised for medical diseases and inpatients aged >18 years admitted due to a surgical procedure and hospitalisation for a period exceeding three days were included. Patients and their treating physicians were interviewed with standardised questionnaire including all VTE and bleeding risk factors described in literature (130 items) on the third day of hospitalisation. Patients not giving informed consent, or receiving anticoagulant treatment for any reason or hospitalised in order to undergo diagnostic investigation without any further therapeutic intervention were excluded.

Results:

A total of 806 patients were enrolled in the study (414 medical and 392 surgical). Most frequent causes of hospitalisation in medical patients were infection (42%), ischemic stroke (14%), cancer (13%), gastrointestinal disease (9%), pulmonary disease (4%), renal disease (3%) and rheumatologic disease (1,4%). Surgical patients were hospitalised for vascular disease (22%) cancer (19,4%) gastrointestinal disease (12,5%), infection (8%), orthopaedic surgery and trauma (14%) or minor surgery (7%). Analysis of the frequency of risk factors for VTE showed that active cancer, recent hospitalisation, venous insufficiency and total bed rest without bathroom privileges were frequent in both groups. Medical patients had significantly more frequently than surgical patients several important predisposing risk factors for VTE. Moreover, medical patient had more frequently than surgical ones bleeding risk factors. The data for the most frequent risk factors are summarised in Table 1.

Table 1.

Frequency of VTE and bleeding risk factors in hospitalised medical and surgical patients.

Risk factorsMedical patients (n=414)Surgical patients (n=392)
VTE risk factors Personal history of cancer 32% 37% 
 Pancreatic, gastro-intestinal, ovarian, prostate, lung or brain cancer 26% 29% 
 Recent hospitalisation (within the last 3 months) for medical illness 30%* 16% 
 Severe infection or sepsis 28%* 2% 
 Total bed rest with bathroom privileges for > 3 days 28%* 2% 
 Total bed rest without bathroom privileges for > 3 days 9% 6% 
 Chemotherapy and/or and hormonotherapy 20%* 6% 
 Metastatic disease 15%* 0 
 Diabetes 18% 10,4% 
 Chronic obstructive pulmonary disease 14%* 3,50% 
 Varicose veins 13% 13% 
 Heart failure NYHA class I or II 10% 7% 
 Heart failure NYHA class III or IV 5% 0% 
 Personal history of VTE 3% 1,5% 
 Peripheral vascular disease 5,5% 5% 
Bleeding risk factors Recent haemorrhage 6% 5% 
 Recent ischemic stroke with haemorrhagic transformation 1,5%* 0% 
 Chronic renal insufficiency 10,5%* 5% 
 Compensated cirrhosis 2,5%* 0,5% 
Risk factorsMedical patients (n=414)Surgical patients (n=392)
VTE risk factors Personal history of cancer 32% 37% 
 Pancreatic, gastro-intestinal, ovarian, prostate, lung or brain cancer 26% 29% 
 Recent hospitalisation (within the last 3 months) for medical illness 30%* 16% 
 Severe infection or sepsis 28%* 2% 
 Total bed rest with bathroom privileges for > 3 days 28%* 2% 
 Total bed rest without bathroom privileges for > 3 days 9% 6% 
 Chemotherapy and/or and hormonotherapy 20%* 6% 
 Metastatic disease 15%* 0 
 Diabetes 18% 10,4% 
 Chronic obstructive pulmonary disease 14%* 3,50% 
 Varicose veins 13% 13% 
 Heart failure NYHA class I or II 10% 7% 
 Heart failure NYHA class III or IV 5% 0% 
 Personal history of VTE 3% 1,5% 
 Peripheral vascular disease 5,5% 5% 
Bleeding risk factors Recent haemorrhage 6% 5% 
 Recent ischemic stroke with haemorrhagic transformation 1,5%* 0% 
 Chronic renal insufficiency 10,5%* 5% 
 Compensated cirrhosis 2,5%* 0,5% 
*

p<0.05

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Conclusion:

COMPASS is the first registry that provides key data on the prevalence of all known VTE and bleeding risk factors in real life medical and surgical patients hospitalised in two countries of European Union. The analysis of the data shows that in addition to risk stemin from the disease or surgical act both medical and surgical patients share common VTE risk factors. The careful analysis of the most frequent and relevant VTE risk factors will allow the derivation of a practical VTE and bleeding risk assessment model taken into account these factors.

Disclosures:

Chrysanthidis:Sanofi-Aventis: Employment.

Topics:
risk assessment, surgical procedures, operative, thromboembolism, venous thromboembolism, awareness, perception, cancer, bed rest, infections, gastrointestinal diseases

Author notes

*

Asterisk with author names denotes non-ASH members.

© 2010 by The American Society of Hematology
2010
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