Factors at Admission Associated With Bleeding Risk in Medical Patients Findings From the IMPROVE Investigators
Identifieur interne : 006A99 ( Main/Exploration ); précédent : 006A98; suivant : 006B00Factors at Admission Associated With Bleeding Risk in Medical Patients Findings From the IMPROVE Investigators
Auteurs : Hervé Decousus [France] ; Victor F. Tapson [Royaume-Uni] ; Jean-François Bergmann [France] ; Beng H. Chong [Australie] ; James B. Froehlich [États-Unis] ; Ajay K. Kakkar [Royaume-Uni] ; Geno J. Merli [États-Unis] ; Manuel Monreal [Espagne] ; Mashio Nakamura [Japon] ; Ricardo Pavanello [Brésil] ; Mario Pini [Italie] ; Franco Piovella [Italie] ; Frederick A. Spencer [Canada] ; Alex C. Spyropoulos [Canada] ; Alexander G. G. Turpie [Canada] ; Rainer B. Zotz [Allemagne] ; Gordon Fitzgerald [États-Unis] ; Frederick A. Anderson [États-Unis]Source :
- Chest : (American College of Chest Physicians) [ 0012-3692 ] ; 2011.
Descripteurs français
- Pascal (Inist)
- Wicri :
- topic : Homme.
English descriptors
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Abstract
Background: Acutely ill, hospitalized medical patients are at risk of VTE. Despite guidelines for VTE prevention, prophylaxis use in these patients is still poor, possibly because of fear of bleeding risk. We used data from the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) to assess in-hospital bleeding incidence and to identify risk factors at admission associated with in-hospital bleeding risk in acutely ill medical patients. Methods: IMPROVE is a multinational, observational study that enrolled 15,156 medical patients. The in-hospital bleeding incidence was estimated by Kaplan-Meier analysis. A multiple regression model analysis was performed to identify risk factors at admission associated with bleeding. Results: The cumulative incidence of major and nonmajor in-hospital bleeding within 14 days of admission was 3.2%. Active gastroduodenal ulcer (OR, 4.15; 95% CI, 2.21-7.77), prior bleeding (OR, 3.64; 95% CI, 2.21-5.99), and low platelet count (OR, 3.37; 95% CI, 1.84-6.18) were the strongest independent risk factors at admission for bleeding. Other bleeding risk factors were increased age, hepatic or renal failure, ICU stay, central venous catheter, rheumatic disease, cancer, and male sex. Using these bleeding risk factors, a risk score was developed to estimate bleeding risk. Conclusions: We assessed the incidence of major and clinically relevant bleeding in a large population of hospitalized medical patients and identified risk factors at admission associated with in-hospital bleeding. This information may assist physicians in deciding whether to use mechanical or pharmacologic VTE prophylaxis.
Affiliations:
- Allemagne, Australie, Brésil, Canada, Espagne, France, Italie, Japon, Royaume-Uni, États-Unis
- Angleterre, Auvergne-Rhône-Alpes, District de Düsseldorf, Grand Londres, Rhénanie-du-Nord-Westphalie, Rhône-Alpes, État de São Paulo, Île-de-France
- Düsseldorf, Londres, Paris, Saint-Étienne, São Paulo
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en" level="a">Factors at Admission Associated With Bleeding Risk in Medical Patients Findings From the IMPROVE Investigators</title><author><name sortKey="Decousus, Herve" sort="Decousus, Herve" uniqKey="Decousus H" first="Hervé" last="Decousus">Hervé Decousus</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>INSERM, CIE3, the University Saint-Etienne, and CHU Saint-Etienne, Hôpital Nord, Service de Médecine Interne et Thérapeutique</s1><s2>Saint-Etienne</s2><s3>FRA</s3><sZ>1 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Auvergne-Rhône-Alpes</region><region type="old region">Rhône-Alpes</region><settlement type="city">Saint-Étienne</settlement></placeName></affiliation></author><author><name sortKey="Tapson, Victor F" sort="Tapson, Victor F" uniqKey="Tapson V" first="Victor F." last="Tapson">Victor F. Tapson</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Duke University Medical Center</s1><s2>Durham, NC</s2><s3>GBR</s3><sZ>2 aut.</sZ></inist:fA14><country>Royaume-Uni</country><wicri:noRegion>Duke University Medical Center</wicri:noRegion></affiliation></author><author><name sortKey="Bergmann, Jean Francois" sort="Bergmann, Jean Francois" uniqKey="Bergmann J" first="Jean-François" last="Bergmann">Jean-François Bergmann</name><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>Hôpital Lariboisiere Clinique Thérapeutique , University Paris Diderot</s1><s2>Paris</s2><s3>FRA</s3><sZ>3 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Chong, Beng H" sort="Chong, Beng H" uniqKey="Chong B" first="Beng H." last="Chong">Beng H. Chong</name><affiliation wicri:level="1"><inist:fA14 i1="04"><s1>St. George Clinical School, University of New South Wales</s1><s2>Sydney, NSW</s2><s3>AUS</s3><sZ>4 aut.</sZ></inist:fA14><country>Australie</country><wicri:noRegion>Sydney, NSW</wicri:noRegion></affiliation></author><author><name sortKey="Froehlich, James B" sort="Froehlich, James B" uniqKey="Froehlich J" first="James B." last="Froehlich">James B. Froehlich</name><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Department of Vascular Medicine , University of Michigan Health System</s1><s2>Ann Arbor, MI</s2><s3>USA</s3><sZ>5 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>Ann Arbor, MI</wicri:noRegion></affiliation></author><author><name sortKey="Kakkar, Ajay K" sort="Kakkar, Ajay K" uniqKey="Kakkar A" first="Ajay K." last="Kakkar">Ajay K. Kakkar</name><affiliation wicri:level="3"><inist:fA14 i1="06"><s1>Centre for Surgical Sciences, Barts and The London, Queen Mary School of Medicine</s1><s2>London</s2><s3>GBR</s3><sZ>6 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Merli, Geno J" sort="Merli, Geno J" uniqKey="Merli G" first="Geno J." last="Merli">Geno J. Merli</name><affiliation wicri:level="1"><inist:fA14 i1="07"><s1>Jefferson Vascular Diseases Center, the Departments of Surgery and Medicine, Thomas Jefferson University Hospital</s1><s2>Philadelphia, PA</s2><s3>USA</s3><sZ>7 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>Philadelphia, PA</wicri:noRegion></affiliation></author><author><name sortKey="Monreal, Manuel" sort="Monreal, Manuel" uniqKey="Monreal M" first="Manuel" last="Monreal">Manuel Monreal</name><affiliation wicri:level="1"><inist:fA14 i1="08"><s1>Servicio de Medicina Interna, Hospital Germans Trias i Pujol</s1><s2>Badalona</s2><s3>ESP</s3><sZ>8 aut.</sZ></inist:fA14><country>Espagne</country><wicri:noRegion>Badalona</wicri:noRegion></affiliation></author><author><name sortKey="Nakamura, Mashio" sort="Nakamura, Mashio" uniqKey="Nakamura M" first="Mashio" last="Nakamura">Mashio Nakamura</name><affiliation wicri:level="1"><inist:fA14 i1="09"><s1>Department of Cardiology, Mie University Graduate School of Medicine</s1><s2>Tsu Mie</s2><s3>JPN</s3><sZ>9 aut.</sZ></inist:fA14><country>Japon</country><wicri:noRegion>Tsu Mie</wicri:noRegion></affiliation></author><author><name sortKey="Pavanello, Ricardo" sort="Pavanello, Ricardo" uniqKey="Pavanello R" first="Ricardo" last="Pavanello">Ricardo Pavanello</name><affiliation wicri:level="3"><inist:fA14 i1="10"><s1>Hospital do Coracao Clinica Medica São Paulo</s1><s2>São Paulo</s2><s3>BRA</s3><sZ>10 aut.</sZ></inist:fA14><country>Brésil</country><placeName><settlement type="city">São Paulo</settlement><region type="state">État de São Paulo</region></placeName></affiliation></author><author><name sortKey="Pini, Mario" sort="Pini, Mario" uniqKey="Pini M" first="Mario" last="Pini">Mario Pini</name><affiliation wicri:level="1"><inist:fA14 i1="11"><s1>Medicina Interna II , Fidenza Hospital</s1><s2>Parma</s2><s3>ITA</s3><sZ>11 aut.</sZ></inist:fA14><country>Italie</country><wicri:noRegion>Parma</wicri:noRegion></affiliation></author><author><name sortKey="Piovella, Franco" sort="Piovella, Franco" uniqKey="Piovella F" first="Franco" last="Piovella">Franco Piovella</name><affiliation wicri:level="1"><inist:fA14 i1="12"><s1>U.O. Angiologia , Fondazione IRCCS Policlinico San Matteo</s1><s2>Pavia</s2><s3>ITA</s3><sZ>12 aut.</sZ></inist:fA14><country>Italie</country><wicri:noRegion>Pavia</wicri:noRegion></affiliation></author><author><name sortKey="Spencer, Frederick A" sort="Spencer, Frederick A" uniqKey="Spencer F" first="Frederick A." last="Spencer">Frederick A. Spencer</name><affiliation wicri:level="1"><inist:fA14 i1="13"><s1>Hamilton Health Sciences General Hospital</s1><s2>Hamilton, ON</s2><s3>CAN</s3><sZ>13 aut.</sZ><sZ>14 aut.</sZ><sZ>15 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Hamilton Health Sciences General Hospital</wicri:noRegion></affiliation></author><author><name sortKey="Spyropoulos, Alex C" sort="Spyropoulos, Alex C" uniqKey="Spyropoulos A" first="Alex C." last="Spyropoulos">Alex C. Spyropoulos</name><affiliation wicri:level="1"><inist:fA14 i1="13"><s1>Hamilton Health Sciences General Hospital</s1><s2>Hamilton, ON</s2><s3>CAN</s3><sZ>13 aut.</sZ><sZ>14 aut.</sZ><sZ>15 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Hamilton Health Sciences General Hospital</wicri:noRegion></affiliation></author><author><name sortKey="Turpie, Alexander G G" sort="Turpie, Alexander G G" uniqKey="Turpie A" first="Alexander G. G." last="Turpie">Alexander G. G. Turpie</name><affiliation wicri:level="1"><inist:fA14 i1="13"><s1>Hamilton Health Sciences General Hospital</s1><s2>Hamilton, ON</s2><s3>CAN</s3><sZ>13 aut.</sZ><sZ>14 aut.</sZ><sZ>15 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Hamilton Health Sciences General Hospital</wicri:noRegion></affiliation></author><author><name sortKey="Zotz, Rainer B" sort="Zotz, Rainer B" uniqKey="Zotz R" first="Rainer B." last="Zotz">Rainer B. Zotz</name><affiliation wicri:level="3"><inist:fA14 i1="14"><s1>Hämostase-Institut Düsseldorf</s1><s2>Düsseldorf</s2><s3>DEU</s3><sZ>16 aut.</sZ></inist:fA14><country>Allemagne</country><placeName><region type="land" nuts="1">Rhénanie-du-Nord-Westphalie</region><region type="district" nuts="2">District de Düsseldorf</region><settlement type="city">Düsseldorf</settlement></placeName></affiliation></author><author><name sortKey="Fitzgerald, Gordon" sort="Fitzgerald, Gordon" uniqKey="Fitzgerald G" first="Gordon" last="Fitzgerald">Gordon Fitzgerald</name><affiliation wicri:level="1"><inist:fA14 i1="15"><s1>Center for Outcomes Research University of Massachusetts Medical School</s1><s2>Worcester, MA</s2><s3>USA</s3><sZ>17 aut.</sZ><sZ>18 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>Center for Outcomes Research University of Massachusetts Medical School</wicri:noRegion></affiliation></author><author><name sortKey="Anderson, Frederick A" sort="Anderson, Frederick A" uniqKey="Anderson F" first="Frederick A." last="Anderson">Frederick A. Anderson</name><affiliation wicri:level="1"><inist:fA14 i1="15"><s1>Center for Outcomes Research University of Massachusetts Medical School</s1><s2>Worcester, MA</s2><s3>USA</s3><sZ>17 aut.</sZ><sZ>18 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>Center for Outcomes Research University of Massachusetts Medical School</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">11-0090219</idno><date when="2011">2011</date><idno type="stanalyst">PASCAL 11-0090219 INIST</idno><idno type="RBID">Pascal:11-0090219</idno><idno type="wicri:Area/PascalFrancis/Corpus">002026</idno><idno type="wicri:Area/PascalFrancis/Curation">003F01</idno><idno type="wicri:Area/PascalFrancis/Checkpoint">001A93</idno><idno type="wicri:explorRef" wicri:stream="PascalFrancis" wicri:step="Checkpoint">001A93</idno><idno type="wicri:doubleKey">0012-3692:2011:Decousus H:factors:at:admission</idno><idno type="wicri:Area/Main/Merge">006F44</idno><idno type="wicri:Area/Main/Curation">006A99</idno><idno type="wicri:Area/Main/Exploration">006A99</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Factors at Admission Associated With Bleeding Risk in Medical Patients Findings From the IMPROVE Investigators</title><author><name sortKey="Decousus, Herve" sort="Decousus, Herve" uniqKey="Decousus H" first="Hervé" last="Decousus">Hervé Decousus</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>INSERM, CIE3, the University Saint-Etienne, and CHU Saint-Etienne, Hôpital Nord, Service de Médecine Interne et Thérapeutique</s1><s2>Saint-Etienne</s2><s3>FRA</s3><sZ>1 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Auvergne-Rhône-Alpes</region><region type="old region">Rhône-Alpes</region><settlement type="city">Saint-Étienne</settlement></placeName></affiliation></author><author><name sortKey="Tapson, Victor F" sort="Tapson, Victor F" uniqKey="Tapson V" first="Victor F." last="Tapson">Victor F. Tapson</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Duke University Medical Center</s1><s2>Durham, NC</s2><s3>GBR</s3><sZ>2 aut.</sZ></inist:fA14><country>Royaume-Uni</country><wicri:noRegion>Duke University Medical Center</wicri:noRegion></affiliation></author><author><name sortKey="Bergmann, Jean Francois" sort="Bergmann, Jean Francois" uniqKey="Bergmann J" first="Jean-François" last="Bergmann">Jean-François Bergmann</name><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>Hôpital Lariboisiere Clinique Thérapeutique , University Paris Diderot</s1><s2>Paris</s2><s3>FRA</s3><sZ>3 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Chong, Beng H" sort="Chong, Beng H" uniqKey="Chong B" first="Beng H." last="Chong">Beng H. Chong</name><affiliation wicri:level="1"><inist:fA14 i1="04"><s1>St. George Clinical School, University of New South Wales</s1><s2>Sydney, NSW</s2><s3>AUS</s3><sZ>4 aut.</sZ></inist:fA14><country>Australie</country><wicri:noRegion>Sydney, NSW</wicri:noRegion></affiliation></author><author><name sortKey="Froehlich, James B" sort="Froehlich, James B" uniqKey="Froehlich J" first="James B." last="Froehlich">James B. Froehlich</name><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Department of Vascular Medicine , University of Michigan Health System</s1><s2>Ann Arbor, MI</s2><s3>USA</s3><sZ>5 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>Ann Arbor, MI</wicri:noRegion></affiliation></author><author><name sortKey="Kakkar, Ajay K" sort="Kakkar, Ajay K" uniqKey="Kakkar A" first="Ajay K." last="Kakkar">Ajay K. Kakkar</name><affiliation wicri:level="3"><inist:fA14 i1="06"><s1>Centre for Surgical Sciences, Barts and The London, Queen Mary School of Medicine</s1><s2>London</s2><s3>GBR</s3><sZ>6 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Merli, Geno J" sort="Merli, Geno J" uniqKey="Merli G" first="Geno J." last="Merli">Geno J. Merli</name><affiliation wicri:level="1"><inist:fA14 i1="07"><s1>Jefferson Vascular Diseases Center, the Departments of Surgery and Medicine, Thomas Jefferson University Hospital</s1><s2>Philadelphia, PA</s2><s3>USA</s3><sZ>7 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>Philadelphia, PA</wicri:noRegion></affiliation></author><author><name sortKey="Monreal, Manuel" sort="Monreal, Manuel" uniqKey="Monreal M" first="Manuel" last="Monreal">Manuel Monreal</name><affiliation wicri:level="1"><inist:fA14 i1="08"><s1>Servicio de Medicina Interna, Hospital Germans Trias i Pujol</s1><s2>Badalona</s2><s3>ESP</s3><sZ>8 aut.</sZ></inist:fA14><country>Espagne</country><wicri:noRegion>Badalona</wicri:noRegion></affiliation></author><author><name sortKey="Nakamura, Mashio" sort="Nakamura, Mashio" uniqKey="Nakamura M" first="Mashio" last="Nakamura">Mashio Nakamura</name><affiliation wicri:level="1"><inist:fA14 i1="09"><s1>Department of Cardiology, Mie University Graduate School of Medicine</s1><s2>Tsu Mie</s2><s3>JPN</s3><sZ>9 aut.</sZ></inist:fA14><country>Japon</country><wicri:noRegion>Tsu Mie</wicri:noRegion></affiliation></author><author><name sortKey="Pavanello, Ricardo" sort="Pavanello, Ricardo" uniqKey="Pavanello R" first="Ricardo" last="Pavanello">Ricardo Pavanello</name><affiliation wicri:level="3"><inist:fA14 i1="10"><s1>Hospital do Coracao Clinica Medica São Paulo</s1><s2>São Paulo</s2><s3>BRA</s3><sZ>10 aut.</sZ></inist:fA14><country>Brésil</country><placeName><settlement type="city">São Paulo</settlement><region type="state">État de São Paulo</region></placeName></affiliation></author><author><name sortKey="Pini, Mario" sort="Pini, Mario" uniqKey="Pini M" first="Mario" last="Pini">Mario Pini</name><affiliation wicri:level="1"><inist:fA14 i1="11"><s1>Medicina Interna II , Fidenza Hospital</s1><s2>Parma</s2><s3>ITA</s3><sZ>11 aut.</sZ></inist:fA14><country>Italie</country><wicri:noRegion>Parma</wicri:noRegion></affiliation></author><author><name sortKey="Piovella, Franco" sort="Piovella, Franco" uniqKey="Piovella F" first="Franco" last="Piovella">Franco Piovella</name><affiliation wicri:level="1"><inist:fA14 i1="12"><s1>U.O. Angiologia , Fondazione IRCCS Policlinico San Matteo</s1><s2>Pavia</s2><s3>ITA</s3><sZ>12 aut.</sZ></inist:fA14><country>Italie</country><wicri:noRegion>Pavia</wicri:noRegion></affiliation></author><author><name sortKey="Spencer, Frederick A" sort="Spencer, Frederick A" uniqKey="Spencer F" first="Frederick A." last="Spencer">Frederick A. Spencer</name><affiliation wicri:level="1"><inist:fA14 i1="13"><s1>Hamilton Health Sciences General Hospital</s1><s2>Hamilton, ON</s2><s3>CAN</s3><sZ>13 aut.</sZ><sZ>14 aut.</sZ><sZ>15 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Hamilton Health Sciences General Hospital</wicri:noRegion></affiliation></author><author><name sortKey="Spyropoulos, Alex C" sort="Spyropoulos, Alex C" uniqKey="Spyropoulos A" first="Alex C." last="Spyropoulos">Alex C. Spyropoulos</name><affiliation wicri:level="1"><inist:fA14 i1="13"><s1>Hamilton Health Sciences General Hospital</s1><s2>Hamilton, ON</s2><s3>CAN</s3><sZ>13 aut.</sZ><sZ>14 aut.</sZ><sZ>15 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Hamilton Health Sciences General Hospital</wicri:noRegion></affiliation></author><author><name sortKey="Turpie, Alexander G G" sort="Turpie, Alexander G G" uniqKey="Turpie A" first="Alexander G. G." last="Turpie">Alexander G. G. Turpie</name><affiliation wicri:level="1"><inist:fA14 i1="13"><s1>Hamilton Health Sciences General Hospital</s1><s2>Hamilton, ON</s2><s3>CAN</s3><sZ>13 aut.</sZ><sZ>14 aut.</sZ><sZ>15 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Hamilton Health Sciences General Hospital</wicri:noRegion></affiliation></author><author><name sortKey="Zotz, Rainer B" sort="Zotz, Rainer B" uniqKey="Zotz R" first="Rainer B." last="Zotz">Rainer B. Zotz</name><affiliation wicri:level="3"><inist:fA14 i1="14"><s1>Hämostase-Institut Düsseldorf</s1><s2>Düsseldorf</s2><s3>DEU</s3><sZ>16 aut.</sZ></inist:fA14><country>Allemagne</country><placeName><region type="land" nuts="1">Rhénanie-du-Nord-Westphalie</region><region type="district" nuts="2">District de Düsseldorf</region><settlement type="city">Düsseldorf</settlement></placeName></affiliation></author><author><name sortKey="Fitzgerald, Gordon" sort="Fitzgerald, Gordon" uniqKey="Fitzgerald G" first="Gordon" last="Fitzgerald">Gordon Fitzgerald</name><affiliation wicri:level="1"><inist:fA14 i1="15"><s1>Center for Outcomes Research University of Massachusetts Medical School</s1><s2>Worcester, MA</s2><s3>USA</s3><sZ>17 aut.</sZ><sZ>18 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>Center for Outcomes Research University of Massachusetts Medical School</wicri:noRegion></affiliation></author><author><name sortKey="Anderson, Frederick A" sort="Anderson, Frederick A" uniqKey="Anderson F" first="Frederick A." last="Anderson">Frederick A. Anderson</name><affiliation wicri:level="1"><inist:fA14 i1="15"><s1>Center for Outcomes Research University of Massachusetts Medical School</s1><s2>Worcester, MA</s2><s3>USA</s3><sZ>17 aut.</sZ><sZ>18 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>Center for Outcomes Research University of Massachusetts Medical School</wicri:noRegion></affiliation></author></analytic><series><title level="j" type="main">Chest : (American College of Chest Physicians)</title><title level="j" type="abbreviated">Chest : (Amer. Coll. Chest Phys.)</title><idno type="ISSN">0012-3692</idno><imprint><date when="2011">2011</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Chest : (American College of Chest Physicians)</title><title level="j" type="abbreviated">Chest : (Amer. Coll. Chest Phys.)</title><idno type="ISSN">0012-3692</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Anesthesia</term><term>Cardiology</term><term>Circulatory system</term><term>Hemorrhage</term><term>Human</term><term>Patient</term><term>Risk</term><term>Risk factor</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Hémorragie</term><term>Facteur risque</term><term>Risque</term><term>Homme</term><term>Malade</term><term>Anesthésie</term><term>Appareil circulatoire</term><term>Cardiologie</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Homme</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Background: Acutely ill, hospitalized medical patients are at risk of VTE. Despite guidelines for VTE prevention, prophylaxis use in these patients is still poor, possibly because of fear of bleeding risk. We used data from the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) to assess in-hospital bleeding incidence and to identify risk factors at admission associated with in-hospital bleeding risk in acutely ill medical patients. Methods: IMPROVE is a multinational, observational study that enrolled 15,156 medical patients. The in-hospital bleeding incidence was estimated by Kaplan-Meier analysis. A multiple regression model analysis was performed to identify risk factors at admission associated with bleeding. Results: The cumulative incidence of major and nonmajor in-hospital bleeding within 14 days of admission was 3.2%. Active gastroduodenal ulcer (OR, 4.15; 95% CI, 2.21-7.77), prior bleeding (OR, 3.64; 95% CI, 2.21-5.99), and low platelet count (OR, 3.37; 95% CI, 1.84-6.18) were the strongest independent risk factors at admission for bleeding. Other bleeding risk factors were increased age, hepatic or renal failure, ICU stay, central venous catheter, rheumatic disease, cancer, and male sex. Using these bleeding risk factors, a risk score was developed to estimate bleeding risk. Conclusions: We assessed the incidence of major and clinically relevant bleeding in a large population of hospitalized medical patients and identified risk factors at admission associated with in-hospital bleeding. This information may assist physicians in deciding whether to use mechanical or pharmacologic VTE prophylaxis.</div></front></TEI><affiliations><list><country><li>Allemagne</li><li>Australie</li><li>Brésil</li><li>Canada</li><li>Espagne</li><li>France</li><li>Italie</li><li>Japon</li><li>Royaume-Uni</li><li>États-Unis</li></country><region><li>Angleterre</li><li>Auvergne-Rhône-Alpes</li><li>District de Düsseldorf</li><li>Grand Londres</li><li>Rhénanie-du-Nord-Westphalie</li><li>Rhône-Alpes</li><li>État de São Paulo</li><li>Île-de-France</li></region><settlement><li>Düsseldorf</li><li>Londres</li><li>Paris</li><li>Saint-Étienne</li><li>São Paulo</li></settlement></list><tree><country name="France"><region name="Auvergne-Rhône-Alpes"><name sortKey="Decousus, Herve" sort="Decousus, Herve" uniqKey="Decousus H" first="Hervé" last="Decousus">Hervé Decousus</name></region><name sortKey="Bergmann, Jean Francois" sort="Bergmann, Jean Francois" uniqKey="Bergmann J" first="Jean-François" last="Bergmann">Jean-François Bergmann</name></country><country name="Royaume-Uni"><noRegion><name sortKey="Tapson, Victor F" sort="Tapson, Victor F" uniqKey="Tapson V" first="Victor F." last="Tapson">Victor F. Tapson</name></noRegion><name sortKey="Kakkar, Ajay K" sort="Kakkar, Ajay K" uniqKey="Kakkar A" first="Ajay K." last="Kakkar">Ajay K. Kakkar</name></country><country name="Australie"><noRegion><name sortKey="Chong, Beng H" sort="Chong, Beng H" uniqKey="Chong B" first="Beng H." last="Chong">Beng H. Chong</name></noRegion></country><country name="États-Unis"><noRegion><name sortKey="Froehlich, James B" sort="Froehlich, James B" uniqKey="Froehlich J" first="James B." last="Froehlich">James B. Froehlich</name></noRegion><name sortKey="Anderson, Frederick A" sort="Anderson, Frederick A" uniqKey="Anderson F" first="Frederick A." last="Anderson">Frederick A. Anderson</name><name sortKey="Fitzgerald, Gordon" sort="Fitzgerald, Gordon" uniqKey="Fitzgerald G" first="Gordon" last="Fitzgerald">Gordon Fitzgerald</name><name sortKey="Merli, Geno J" sort="Merli, Geno J" uniqKey="Merli G" first="Geno J." last="Merli">Geno J. Merli</name></country><country name="Espagne"><noRegion><name sortKey="Monreal, Manuel" sort="Monreal, Manuel" uniqKey="Monreal M" first="Manuel" last="Monreal">Manuel Monreal</name></noRegion></country><country name="Japon"><noRegion><name sortKey="Nakamura, Mashio" sort="Nakamura, Mashio" uniqKey="Nakamura M" first="Mashio" last="Nakamura">Mashio Nakamura</name></noRegion></country><country name="Brésil"><region name="État de São Paulo"><name sortKey="Pavanello, Ricardo" sort="Pavanello, Ricardo" uniqKey="Pavanello R" first="Ricardo" last="Pavanello">Ricardo Pavanello</name></region></country><country name="Italie"><noRegion><name sortKey="Pini, Mario" sort="Pini, Mario" uniqKey="Pini M" first="Mario" last="Pini">Mario Pini</name></noRegion><name sortKey="Piovella, Franco" sort="Piovella, Franco" uniqKey="Piovella F" first="Franco" last="Piovella">Franco Piovella</name></country><country name="Canada"><noRegion><name sortKey="Spencer, Frederick A" sort="Spencer, Frederick A" uniqKey="Spencer F" first="Frederick A." last="Spencer">Frederick A. Spencer</name></noRegion><name sortKey="Spyropoulos, Alex C" sort="Spyropoulos, Alex C" uniqKey="Spyropoulos A" first="Alex C." last="Spyropoulos">Alex C. Spyropoulos</name><name sortKey="Turpie, Alexander G G" sort="Turpie, Alexander G G" uniqKey="Turpie A" first="Alexander G. G." last="Turpie">Alexander G. G. Turpie</name></country><country name="Allemagne"><region name="Rhénanie-du-Nord-Westphalie"><name sortKey="Zotz, Rainer B" sort="Zotz, Rainer B" uniqKey="Zotz R" first="Rainer B." last="Zotz">Rainer B. Zotz</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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