Assessment of thromboprophylaxis in medical patients hospitalized in Andalusia. A multicenter study

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"apellidos" => "Marín-León" "email" => array:1 [ 0 => "ignacio.marin.sspa@juntadeandalucia.es" ] "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] 2 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] 3 => array:2 [ "etiqueta" => "*" "identificador" => "cor1" ] ] ] 6 => array:1 [ "colaborador" => "en nombre del GRUPO COLABORATIVO PRETEMED" ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Universitario Valme, Sevilla, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Universitario Virgen Rocío, Sevilla, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "IBIS-CSIC-US-CIBERESP, Sevilla, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Fundación Enebro, Sevilla, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Adecuación de tromboprofilaxis en pacientes médicos hospitalizados en Andalucía. Estudio multicéntrico" ] ] "textoCompleto" => "BackgroundVenous thromboembolism (VTE) is the most significant preventable cause of death in the hospital setting. Despite advances in its treatment, 1 of every 10 deaths in the hospital is due to VTE, which, in 75% of the cases, occurs in patients with nonsurgical diseases.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> It is estimated that the disease causes 150,000–200,000 deaths annually in the U.S.<a class="elsevierStyleCrossRefs" href="#bib0010">2,3</a> and 12% of deaths in Europe.<a class="elsevierStyleCrossRefs" href="#bib0020">4,5</a>Most of these deaths are sudden or in the first 2h before treatment can be started effectively. Prophylaxis is therefore the key action in this condition<a class="elsevierStyleCrossRefs" href="#bib0030">6,7</a> and prevents long-term complications.<a class="elsevierStyleCrossRefs" href="#bib0040">8,9</a>Available information on the risk of VTE for hospitalized medical patients is qualitatively and quantitatively less than for surgical patients.<a class="elsevierStyleCrossRefs" href="#bib0030">6,10</a> Various studies have demonstrated that, for medical patients, thromboprophylaxis is an effective measure for lowering the incidence of VTE.<a class="elsevierStyleCrossRefs" href="#bib0035">7,11–14</a> However, according to a multinational study,<a class="elsevierStyleCrossRef" href="#bib0075">15</a> prevention is only used for 58.5% of hospitalized surgical patients and for 41.5% of the hospitalized medical patients.It has been reported that the greatest underutilization of thromboprophylaxis in hospitalized medical patients is due to the concomitant presence of various risk factors; up to 80% of cases have more than 3 risk factors for VTE.<a class="elsevierStyleCrossRef" href="#bib0080">16</a> Stratifying the risk of VTE is thereby more complicated for these patients.The underutilization of thromboembolic prophylaxis for medical patients is a problem that can be improved using clinical practice guidelines such as the PRETEMED guidelines,<a class="elsevierStyleCrossRef" href="#bib0085">17</a> the first guidelines on evidence-based VTE prophylaxis. These guidelines help calculate the specific risk of VTE in a particular medical patient when several risk factors occur simultaneously and establish recommendations for preventive measures using a weighted risk scale, in contrast to other well-publicized guidelines that offer more generic recommendations.<a class="elsevierStyleCrossRefs" href="#bib0030">6,18</a>However, the knowledge available in our community on the risk profile of VTE and the appropriateness of thromboprophylaxis measures to the standards of clinical practice guidelines on hospitalized medical patients are limited to that provided by a subanalysis of the Spanish cases of the 2006 multinational study ENDORSE, in which 7 Andalusian hospitals participated,<a class="elsevierStyleCrossRef" href="#bib0095">19</a> and several single-center studies that included a low number of cases.<a class="elsevierStyleCrossRefs" href="#bib0100">20–22</a> To improve our understanding of the current clinical practice in our community, we developed a multicenter study to assess the risk profile of VTE and the appropriateness of thromboprophylaxis for hospitalized medical patients in Andalusia.Patients and methodsThis was an observational, cross-sectional, multicenter study performed between February 2010 and November 2010. All internal medicine units of the network of 36 public or subsidized hospitals of the Andalusia public healthcare system were sent an invitation by mail. Sixteen of these institutions agreed to participate, including hospitals from the 3 levels of complexity existing in our healthcare network: four regional hospitals, six general hospitals and six district hospitals. In each center, a single investigator consecutively included the first 20 eligible, nonsurgical patients who had been discharged (or exitus) from internal medicine since the start of the study.The inclusion criteria were an age ≥18 years and consent to participate in the study. The exclusion criteria were hospitalization for VTE, undergoing chronic anticoagulation therapy prior to hospitalization, hypersensitivity to low-molecular-weight heparins (LMWHs), history of heparin-induced thrombocytopenia, active hemorrhaging in the 3 months prior to inclusion, severe hepatic function disorder (Child–Pugh scale B) and known bleeding disorders (activated partial thromboplastin times >60s prior to hospitalization and international normalized ratio >1.5).The study variables were recorded at discharge in a standardized format based on the patients’ discharge report and medical history. The decision to start thromboprophylaxis and the type of thromboprophylaxis prescribed was, in each case, at the discretion of the clinician responsible for the patients’ care. No active dissemination or implementation activities were conducted for the standards employed (the 2007 PRETEMED guidelines).<a class="elsevierStyleCrossRef" href="#bib0085">17</a>The study variables included demographic characteristics (age, sex, weight, height, body mass index, disease for which the patient was hospitalized, length of hospital stay in days, VTE risk factors, triggers, associated medical diseases, drugs and other factors considered in the PRETEMED guidelines); the 2007 PRETEMED level of adjusted risk at admission and at hospital discharge; and risk factors for hemorrhaging, specifically concomitant treatment with gastro-damaging drugs or antiplatelets; cerebral, gastrointestinal or genitourinary hemorrhaging beyond 3 months prior to inclusion; other organic lesions susceptible to bleeding; uncontrolled arterial hypertension; blood dyscrasia, hemophilia; and active gastroduodenal ulceration.As outcome variables, we measured the prescription of thromboprophylaxis with (a) physical measures, e.g. elastic compression stockings and intermittent pressure therapy; and (b) LMWHs (type, dosage, duration), at admission and at discharge. We also measured the appropriateness of thromboprophylaxis compared with the 2007 PRETEMED standard, which is classified as underutilization (absence of drug thromboprophylaxis in probands with risk ≥4), overutilization (use of drug thromboprophylaxis in probands with risk <4), appropriate use (use of drug thromboprophylaxis in probands with risk ≥4 or the non-use of drug thromboprophylaxis in patients with risk <4), and all-cause inhospital mortality.For the descriptive study, the quantitative variables are expressed as measures of central tendency and dispersion (mean±standard deviation), and the qualitative variables are expressed as frequencies. For the bivariate analysis, we used the chi-squared distribution. The level of statistical significance was established at a value of p<.05. The statistical analysis was performed using the IBM statistical bundle SPSS version 19.0.ResultsDuring the study period, a total of 304 patients were included. Of these, 11 were excluded, in 9 cases for not meeting one of the inclusion/exclusion criteria and in 2 for not specifying whether they met the criteria; these patients were considered lost values. The definitive analysis was conducted with 293 patients. The all-cause hospital mortality was 2.7% (8 patients).The complete relationship of VTE risk factors is shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. The most common risk factors were an age >60 years and being bed-ridden for more than 4 days.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The calculation for the weighted risk of VTE on admission (according to the PRETEMED guideline) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2A</a>) showed that 43.4% of the patients (126 participants) had a low risk (RA<4), 8.3% (n=24) had a moderate risk (RA=4) and the remaining 48.1% (n=139) had a high risk (RA>4). Similarly, at hospital discharge (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 2B</a>), 58.5% of the patients (141 participants) had a low risk, 10.4% (n=25) had a moderate risk and the remaining 31.1% (n=75) had a high risk.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia>On admission and discharge, thromboprophylaxis with LMWHs was prescribed for 265 patients (91.7%) and 49 patients (17.3%), respectively. The analysis of the appropriateness of thromboprophylaxis to the recommendations of the PRETEMED guidelines, both at admission and at discharge is shown in <a class="elsevierStyleCrossRefs" href="#tbl0010">Tables 2A and 2B</a>. On admission, the rates of underutilization, overutilization and appropriate use of LMWHs according to the 2007 PRETEMED criteria were 1.7% (n=5), 38.4% (n=111) and 59.9% (n=173), respectively. On discharge, these rates were 19.9% (n=48), 5.4% (n=13) and 74.7% (n=180), respectively.In terms of risk factors for hemorrhage, 34.8% (n=101) had 1 risk factor, 7.6% (n=22) had 2 and 1% (n=3) had 3 or more. The most common risk factor for hemorrhage was the concomitant use of gastro-damaging drugs or antiplatelets (32.8%).Of the 265 patients who were prescribed thromboembolic prophylaxis with LMWHs on admission, 226 (78.5%) were treated with enoxaparin at a dosage of 40mg/24h and 39 (13.5%) were treated with bemiparin at a dosage of 3500 UI/24h. On admission, other antithrombotic measures such as elastic stockings and intermittent pressure therapy were not used. On discharge, 49 patients were treated with LMWHs. Treatment with elastic stockings was prescribed for only 1 case, and none of the cases employed intermittent pressure therapy.The analysis of the variables related to the appropriateness on admission is shown in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 3</a>. There was no statistical association for the appropriateness by sex. The appropriateness was less among the younger patients, with lower hemorrhagic risk and with no triggers of acute organ disease or infection.<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>DiscussionThis multicenter study describes for the first time the risk of VTE in a region of Spain for patients hospitalized for medical diseases and assesses the appropriateness of prescribed thromboprophylaxis to a standard based on scientific evidence.We found that only 56.4% of the patients had a moderate to high risk of VTE on admission, while 91.7% were treated with thromboprophylaxis, despite 8.6% of the patients having a considerable risk of hemorrhage (2 or more factors). At hospital discharge, 41.5% of the patients had a risk of VTE but only 17.3% were treated with thromboprophylaxis. These results reveal a panorama of poor appropriateness due to the overutilization of prophylaxis with LMWHs in 38.4% of the hospitalized patients and in 5.4% at discharge. At the same time, underutilization of thromboprophylaxis was detected in 1.7% and 19.9% of patients at admission and at discharge, respectively, with 14.8% of patients having greater inappropriateness of thromboprophylaxis during their hospital admission. An age less than 60 years and a low risk of bleeding are the main factors that explain the inappropriateness, with the resulting increase in overutilization.Our findings should be viewed in the context of the disease burden represented by VTE in hospitalized patients, with higher mortality and complications than in surgical patients.<a class="elsevierStyleCrossRef" href="#bib0095">19</a> Spanish epidemiological data show the progressive increase in VTE during hospitalization for a medical disease, reaching 35% of patients diagnosed with VTE between 1999 and 2003,<a class="elsevierStyleCrossRef" href="#bib0005">1</a> despite the preventable nature of VTE.<a class="elsevierStyleCrossRefs" href="#bib0055">11–14</a>The Agency for Healthcare Research and Quality considers thromboprophylaxis one of the most effective safety measures for patients who are hospitalized.<a class="elsevierStyleCrossRef" href="#bib0115">23</a>Several studies have evaluated the impact of the recommendations of clinical practice guidelines on the appropriateness of thromboprophylaxis for patients admitted for medical diseases. The ENDORSE project, a study performed between 2006 and 2007 at hospitals in 32 countries that used the risk criteria of the American College of Chest Physicians (ACCP), showed similar data to those of our study, in which thromboprophylaxis in conditions of high risk is only used in 58% of surgical patients and in 39.5% of medical patients.<a class="elsevierStyleCrossRef" href="#bib0075">15</a> In the analysis of the subgroup of Spanish participants, thromboprophylaxis is significantly superior. However, more than 35% of the evaluated Spanish medical patients were not treated with appropriate prophylaxis.<a class="elsevierStyleCrossRef" href="#bib0095">19</a>There have been several single-center studies in Spain with a limited number of patients<a class="elsevierStyleCrossRefs" href="#bib0100">20–22</a> that have confirmed the inappropriateness of thromboprophylaxis in hospitalized nonsurgical patients. The study performed at Hospital Carlos Haya compared the appropriateness versus two different standards, the criteria of the PRETEMED guidelines and those of ACCP. They found that in both situations the inappropriateness was greater than 25%, showing that the PRETEMED guidelines overestimate the risk of VTE, when compared with the ACCP guidelines, which demonstrates the need to intensify efforts to stratify the risk of VTE in medical patients.<a class="elsevierStyleCrossRef" href="#bib0110">22</a>In the Andalusian hospitals of our study, 47.8% of the patients who were admitted for medical diseases had a PRETEMED score with a potentially high or very high risk of developing VTE (more than 40% patient/year). This rate is slightly higher than the 41.5% of medical patients at risk recorded in the ENDORSE study<a class="elsevierStyleCrossRef" href="#bib0075">15</a> but lower than the 55.1% of patients in the CURVE study in 29 Canadian hospitals.<a class="elsevierStyleCrossRef" href="#bib0090">18</a> Given that the risk stratification in both studies was conducted according to the criteria of the ACCP guidelines, the observed differences could be due to the greater imprecision of the criteria for assessing the risk with this guide, given that the demographic differences of the patients included in these studies (mean age slightly higher than that recorded in the ENDORSE study [69 vs. 67 years] and lower presence of women [42.2% vs. 49%]) do not seem to explain the differences in the proportion of patients at risk.In the multinational ENDORSE study, the appropriateness rate for thromboprophylaxis at admission for medical patients was less than that in our study (39.5% vs. 59.9%).<a class="elsevierStyleCrossRef" href="#bib0075">15</a>In the subanalysis of data from the Spanish participants of the ENDORSE study, the proportion of medical patients at risk of VTE who were treated with prophylaxis at admission was 64%, a value that is among the highest when compared with the other countries participating in the ENDORSE study.<a class="elsevierStyleCrossRef" href="#bib0095">19</a> In our study, however, the patients at high risk were treated with appropriate thromboprophylaxis in 96.4% of the cases.In our study, the prophylaxis of VTE was performed almost exclusively with LMWHs, both at admission and at hospital discharge, a similar situation to that described in the ENDORSE study.<a class="elsevierStyleCrossRef" href="#bib0075">15</a> For 19 patients (8% of those included in the study), the heparin dosage used was insufficient; 10 of these patients also had no indication for prophylaxis.Regarding the use of physical measures for mechanical prophylaxis, only 1 patient was prescribed elastic compression at discharge, and none of the patients underwent intermittent pressure therapy (either at admission or discharge), even patients at low to medium risk of VTE. These results are lower than those registered in other studies.<a class="elsevierStyleCrossRefs" href="#bib0095">19,22</a>Various strategies have been proposed for improving the appropriateness of thromboprophylaxis for hospitalized medical patients, with results that improve the underutilization in high-risk patients but do not improve overall appropriateness.<a class="elsevierStyleCrossRefs" href="#bib0015">3,24</a> Surgery implemented according to the PRETEMED guidelines, with electronic alerts, reduced the number of cases of VTE during hospitalization (OR, 0.36; 95% CI 0.12–0.98).<a class="elsevierStyleCrossRef" href="#bib0125">25</a>The limitations of the study include the representativeness of the sample. Although almost half of the institutions of the Andalusian hospital network participated in the study and the inclusion of patients was random, as well as the fact that we excluded a number of diseases with high hemorrhagic risk, we cannot fully ensure that the sample was representative of the overall population of hospitalized medical patients and that the results can be extrapolated to hospitalized patients in other medical areas. Another limitation of our study is the possible observation bias, given that the researchers knew of their participation in the study and used a data collection notebook, which could have influenced the therapeutic management by these practitioners. The study protocol did, however, clearly specify that it was up to the researcher's discretion whether to indicate thromboembolic prophylaxis or not.Despite these limitations, it should be noted that our study is the first to analyze the appropriateness of thromboprophylaxis at discharge, given that VTE affects both hospitalized patients and outpatients.Our data are consistent with those of other studies that indicate the prescription of thromboprophylaxis as an area of improvement for hospitalized nonsurgical patients.<a class="elsevierStyleCrossRef" href="#bib0130">26</a> In particular, our study observed an overutilization that suggests that thromboprophylaxis is prescribed almost routinely, despite the risks, cost and disadvantages it entails. The use of evidence-based CPGs could therefore help improve the appropriateness of prescribed prophylaxis.In short, the present multicenter study has helped confirmed that, in Andalusia, patients hospitalized in internal medicine units have a high risk of venous thromboembolism and that the use of thromboprophylaxis with LMWHs is practically routine during admission, regardless of the risk threshold of VTE. This identifies high inappropriateness due to overutilization of thromboprophylaxis during admission and underutilization at discharge. This situation can be corrected through specific interventions to facilitate the identification of VTE risk, followed by the application of the recommended prophylaxis that results in the greatest benefit and least harm.<elsevierMultimedia ident="tb0005"></elsevierMultimedia>FundingThe study was conducted with partial financial help from Sanofi-Aventis and institutional support from the Andalusian Internal Medicine Society (Sociedad Andaluza de Medicina Interna, SADEMI).Conflicts of interestThe authors declare that the study received partial funding from Sanofi-Aventis for logistical support in the distribution and collection of case report forms." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres468584" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec491223" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres468583" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes y objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec491224" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Background" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Patients and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0035" "titulo" => "Funding" ] 9 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflicts of interest" ] 10 => array:2 [ "identificador" => "xack140841" "titulo" => "Acknowledgements" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-06-29" "fechaAceptado" => "2014-09-11" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec491223" "palabras" => array:4 [ 0 => "Prophylaxis" 1 => "Venous thrombosis" 2 => "Clinical guidelines" 3 => "Treatment adjustment" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec491224" "palabras" => array:4 [ 0 => "Profilaxis" 1 => "Trombosis venosa" 2 => "Guías clínicas" 3 => "Adecuación tratamiento" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "Background and objectivesHospitalized patients are a population at risk for venous thromboembolism (VTE). The PRETEMED-2007 clinical practice guidelines help identify high-risk medical patients who are suited to thromboprophylaxis. These guidelines therefore provide a standard for prophylaxis in such patients. We evaluated the risk of VTE and the adjustment of thromboprophylaxis to the standards of the PRETEMED-2007 guidelines in patients hospitalized in internal medicine departments. Patients and methodsAn observational, cross-sectional multicenter study was performed in 2010 in 16 hospitals in Andalusia and included 20 consecutive patients per center. The study variables were age, sex, risk factors for VTE and hemorrhage, the risk-adjusted PRETEMED of VTE, adjustment of thromboembolic prophylaxis at admission and at discharge and hospital mortality. ResultsThe study included 293 patients (57.8% men) with a mean age of 69 (±15) years. The most common triggers for VTE were acute severe infection (27.3%) and neoplasia (16.4%). Some 43.4% of the patients presented a risk of hemorrhage. The risk of VTE at admission and discharge was high in 47.8% and 31% and moderate in 8.2% and 10.6%, respectively. A total of 91.7% and 17.3% of the patients underwent prophylaxis with low-molecular-weight heparin on admission and at discharge, respectively. The prescription was appropriate for 59.9% of the patients at admission (overutilization 38.4%, underutilization 1.7%) and for 74.7% at discharge (overutilization 5.4%, underutilization 19.9%). The adjustment was greater in patients older than 60 years and with greater hemorrhagic risk. ConclusionsFor 60% of the patients admitted to the departments of internal medicine in Andalusia, the thromboprophylaxis was appropriate. The inadequacy of thromboprophylaxis (40%) is mostly due to overutilization. These results suggest significant space for improvement." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "Antecedentes y objetivosLos pacientes hospitalizados constituyen una población de riesgo para la enfermedad tromboembólica venosa (ETV). La guía de práctica clínica PRETEMED-2007 permite identificar a los pacientes médicos de alto riesgo susceptibles de tromboprofilaxis, y así disponer de un estándar de profilaxis en tales pacientes. Hemos evaluado el riesgo de ETV y la adecuación de tromboprofilaxis a los estándares de la guía PRETEMED-2007 en los pacientes hospitalizados en servicios de medicina interna. Pacientes y métodosEstudio observacional transversal y multicéntrico realizado en 2010 en 16 hospitales de Andalucía que incluyen 20 pacientes consecutivos por centro. Variables: edad, sexo, factores de riesgo de ETV y hemorragia, riesgo ajustado PRETEMED de ETV, adecuación de profilaxis tromboembólica al ingreso y al alta y mortalidad intrahospitalaria. ResultadosSe incluyeron 293 pacientes (57,8% varones, edad media de 69±15 años). Los factores precipitantes de ETV más frecuentes fueron: infección aguda grave (27,3%) y neoplasia (16,4%). El 43,4% presentaba riesgo de hemorragia. El riesgo de ETV al ingreso y alta fue elevado en el 47,8 y 31% y moderado en el 8,2 y 10,6% respectivamente. Recibieron profilaxis con heparina de bajo peso molecular el 91,7% al ingreso y el 17,3% al alta. La prescripción fue adecuada en el 59,9% al ingreso (sobreuso 38,4%, infrauso 1,7%) y en el 74,7% al alta (sobreuso 5,4%, infrauso 19,9%). La adecuación fue mayor en pacientes mayores de 60 años y con mayor riesgo hemorrágico. ConclusionesEn el 60% de los enfermos que ingresan en los servicios de medicina interna de Andalucía la tromboprofilaxis es adecuada. La inadecuación de tromboprofilaxis (40%) es mayoritariamente por sobreindicación. Estos resultados sugieren un amplio campo de mejora." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes y objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Navarro Puerto MA, Medrano Ortega FJ, Izquierdo Guerrero R, Calderón Sandubete E, Buzón-Barrera ML, Marín-León I, et al. Adecuación de tromboprofilaxis en pacientes médicos hospitalizados en Andalucía. Estudio multicéntrico. Rev Clin Esp. 2015;215:141–147." ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "The PRETEMED COLLABORATIVE GROUP consisted of the following physicians from the departments of internal medicine at the participating hospitals: regional hospitals: I. Martín Garrido from Hospital Virgen del Rocío and J.C. San González from Hospital Virgen Macarena (Seville), M.A. Blanco Molina from Hospital Reina Sofía (Cordoba), Hospital Virgen de las Nieves (Granada); general hospitals: R. Gómez Herrero, R. González Ferrer from Hospital Valme (Sevilla), F. Muñoz Beamud, J.J. Cordero Soriano, M.J. Marchena González from Hospital Juan Ramón Jiménez (Huelva), M. Marcos Herrera from Hospital Costa del Sol (Marbella, Malaga), San Cecilio (Granada), Hospital Complex of Jaén (Jaén), M.P. Martínez Cortés from Hospital Torrecárdenas (Almería); and district hospitals: J. Álvarez Suero of Hospital de la Merced (Osuna, Seville), F. Díaz Navarro of Hospital Infanta Elena and J.A. Chacón Serrano of Hospital Riotinto (Huelva), R. Tirado Miranda of Hospital Infanta Margarita (Cabra, Cordoba), J.N. Alcalá Pedrajas of Hospital Valle de los Pedroches (Pozoblanco, Cordoba) and G. Ojeda Burgos of Hospital Xanit (Malaga)." "etiqueta" => "Appendix A" "titulo" => "[{(Annex)}]" "identificador" => "sec0045" ] ] ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "The weight adjusted according to PRETEMED-2007 is shown in the parentheses.Abbreviations: COPD, chronic obstructive pulmonary disease; DVT, deep vein thrombosis; HIV, human immunodeficiency virus; SD, standard deviation; SVT, superficial venous thrombosis." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">% \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Triggering processes</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Severe acute infection (2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Neoplasia (2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">COPD with severe decompensation (3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Class III heart failure (2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Acute stroke with lower limb paralysis (3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Class IV heart failure (3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Acute myocardial infarction (3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Lower limb trauma without surgery (3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Active inflammatory bowel disease (2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Airplane flights >6h (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Processes associated with medical disease</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Diabetes mellitus (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">95 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Lower limb paralysis (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Previous DVT (2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Previous SVT (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">HIV infection (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Nephrotic syndrome (2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Vasculitis (2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Use of drugs</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Antidepressants (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Antipsychotics (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Chemotherapy (2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Tamoxifen–Raloxifene (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Hormonal contraceptives (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top">Other factors</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Female sex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">124 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">42.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Mean age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 SD \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Mean BMI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 SD \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Mean stay \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 SD \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Age >60years (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">216 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">73.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Bed rest >4days (2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">139 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Obesity (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">85 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Smoking (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Central venous catheter (1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab725468.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Clinical characteristics and risk factors for venous thromboembolism in the study population." ] ] 1 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2A" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "Values without asterisks indicate adequate practice.Abbreviations: LMWH, low-molecular-weight heparins." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">PRETEMED risk at admission</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><4 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">4 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">>4 \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Prophylaxis with LMWH, n (%)</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">111 (38.4)<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 (6.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">134 (46.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 (5.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (1.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (1.7)<a class="elsevierStyleCrossRef" href="#tblfn0015">c</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Total<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">126 (43.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 (8.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">139 (48.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab725467.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Four cases with lost values." ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "Overuse." ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "c" "nota" => "Underuse." ] ] ] "descripcion" => array:1 [ "en" => "Adequacy of thromboprophylaxis with low-molecular-weight heparins according to PRETEMED at admission." ] ] 2 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 2B" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "Values without asterisks indicate adequate practice.Abbreviations: LMWH, low-molecular-weight heparins." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">PRETEMED risk at discharge</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><4 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">4 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">>4 \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Prophylaxis with LMWH, n (%)</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 (5.4)<a class="elsevierStyleCrossRef" href="#tblfn0030">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (1.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 (11.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">128 (53.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 (8.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48 (19.9)<a class="elsevierStyleCrossRef" href="#tblfn0035">c</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Total<a class="elsevierStyleCrossRef" href="#tblfn0025">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">141 (58.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 (10.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75 (31.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab725465.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0025" "etiqueta" => "a" "nota" => "52 cases with lost values." ] 1 => array:3 [ "identificador" => "tblfn0030" "etiqueta" => "b" "nota" => "Overuse." ] 2 => array:3 [ "identificador" => "tblfn0035" "etiqueta" => "c" "nota" => "Underuse." ] ] ] "descripcion" => array:1 [ "en" => "Adequacy of thromboprophylaxis with low-molecular-weight heparins according to PRETEMED at discharge." ] ] 3 => array:7 [ "identificador" => "tbl0020" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "Heart disease: class III and IV heart failure of the New York Heart Association classification and/or acute myocardial infarction.COPD, chronic obstructive pulmonary disease; acute stroke, acute stroke with paralysis of the lower limbs; RF, risk factors." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variables \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Adequaten (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Inadequaten (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p<a class="elsevierStyleCrossRef" href="#tblfn0040">a</a> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Sex</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">163 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">96 (58.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">67 (41.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.743 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">120 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">73 (60.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47 (39.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Age >60 years</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">213 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">140 (65.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">73 (34.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">76 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33 (43.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43 (56.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Age>85 years</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 (63.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 (36.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.598 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">253 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">150 (59.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">103 (40.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Infection</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">70 (87.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (12.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">209 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">103 (49.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">106 (50.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Heart disease</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">42 (87.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (12.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">241 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">131 (54.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">110 (45.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Neoplasia</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35 (74.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (25.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.026 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">242 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">138 (57.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">104 (43.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">COPD</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28 (90.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (9.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">258 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">145 (56.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">113 (43.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Acute stroke</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.002 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">275 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">159 (57.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">116 (42.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">≥2 RFs for hemorrhage</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 (80.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (20.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.031 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">261 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">151 (57.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">110 (42.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab725466.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0040" "etiqueta" => "a" "nota" => "Chi-squared." ] ] ] "descripcion" => array:1 [ "en" => "Factors related to the adequacy of thromboprophylaxis." ] ] 4 => array:5 [ "identificador" => "tb0005" "tipo" => "MULTIMEDIATEXTO" "mostrarFloat" => false "mostrarDisplay" => true "texto" => array:1 [ "textoCompleto" => "What we know?VTE is a common and preventable disease in hospital settings for patients treated either by surgical or medical departments. The PRETEMED 2007 guidelines help calculate the risk of VTE and offers recommendations based on rigorous clinical studies. This study analyzes the adequacy of thromboprophylaxis in patients hospitalized in the departments of internal medicine of 16 hospitals in Andalusia.What this article provides?Almost half of approximately 300 patients (mean age of 69 years) had a high risk of VTE at admission, which decreased to 30% by the time the patients were discharged. Thromboprophylaxis was adequate in 60% and 75% of cases at admission and discharge, respectively. The inadequacy of thromboprophylaxis was mostly due to overindication.The Editors" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:26 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Estudio sobre la enfermedad tromboembólica en España" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "Grupo Multidisciplinar para el Estudio de la Enfermedad Tromboembólica en España" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2006" "editorial" => "Imago Concept Image DEV" "editorialLocalizacion" => "Madrid" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The epidemiology of venous thromboembolism" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R.H. 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Original article

Assessment of thromboprophylaxis in medical patients hospitalized in Andalusia. A multicenter study

Adecuación de tromboprofilaxis en pacientes médicos hospitalizados en Andalucía. Estudio multicéntrico

M.A. Navarro Puertoa, F.J. Medrano Ortegab,c, R. Izquierdo Guerrerob, E. Calderón Sandubeteb,c, M.L. Buzón-Barrerad, I. Marín-Leónb,c,d,

Corresponding author

ignacio.marin.sspa@juntadeandalucia.es

Corresponding author.

, en nombre del GRUPO COLABORATIVO PRETEMED

a Servicio de Medicina Interna, Hospital Universitario Valme, Sevilla, Spain

b Servicio de Medicina Interna, Hospital Universitario Virgen Rocío, Sevilla, Spain

c IBIS-CSIC-US-CIBERESP, Sevilla, Spain

d Fundación Enebro, Sevilla, Spain

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        "titulo" => "Adecuaci&#243;n de tromboprofilaxis en pacientes m&#233;dicos hospitalizados en Andaluc&#237;a&#46; Estudio multic&#233;ntrico"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">Venous thromboembolism &#40;VTE&#41; is the most significant preventable cause of death in the hospital setting&#46; Despite advances in its treatment&#44; 1 of every 10 deaths in the hospital is due to VTE&#44; which&#44; in 75&#37; of the cases&#44; occurs in patients with nonsurgical diseases&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It is estimated that the disease causes 150&#44;000&#8211;200&#44;000 deaths annually in the U&#46;S&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> and 12&#37; of deaths in Europe&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Most of these deaths are sudden or in the first 2<span class="elsevierStyleHsp" style=""></span>h before treatment can be started effectively&#46; Prophylaxis is therefore the key action in this condition<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7</span></a> and prevents long-term complications&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Available information on the risk of VTE for hospitalized medical patients is qualitatively and quantitatively less than for surgical patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;10</span></a> Various studies have demonstrated that&#44; for medical patients&#44; thromboprophylaxis is an effective measure for lowering the incidence of VTE&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;11&#8211;14</span></a> However&#44; according to a multinational study&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> prevention is only used for 58&#46;5&#37; of hospitalized surgical patients and for 41&#46;5&#37; of the hospitalized medical patients&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">It has been reported that the greatest underutilization of thromboprophylaxis in hospitalized medical patients is due to the concomitant presence of various risk factors&#59; up to 80&#37; of cases have more than 3 risk factors for VTE&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> Stratifying the risk of VTE is thereby more complicated for these patients&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The underutilization of thromboembolic prophylaxis for medical patients is a problem that can be improved using clinical practice guidelines such as the PRETEMED guidelines&#44;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> the first guidelines on evidence-based VTE prophylaxis&#46; These guidelines help calculate the specific risk of VTE in a particular medical patient when several risk factors occur simultaneously and establish recommendations for preventive measures using a weighted risk scale&#44; in contrast to other well-publicized guidelines that offer more generic recommendations&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;18</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">However&#44; the knowledge available in our community on the risk profile of VTE and the appropriateness of thromboprophylaxis measures to the standards of clinical practice guidelines on hospitalized medical patients are limited to that provided by a subanalysis of the Spanish cases of the 2006 multinational study ENDORSE&#44; in which 7 Andalusian hospitals participated&#44;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> and several single-center studies that included a low number of cases&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#8211;22</span></a> To improve our understanding of the current clinical practice in our community&#44; we developed a multicenter study to assess the risk profile of VTE and the appropriateness of thromboprophylaxis for hospitalized medical patients in Andalusia&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and methods</span><p id="par0035" class="elsevierStylePara elsevierViewall">This was an observational&#44; cross-sectional&#44; multicenter study performed between February 2010 and November 2010&#46; All internal medicine units of the network of 36 public or subsidized hospitals of the Andalusia public healthcare system were sent an invitation by mail&#46; Sixteen of these institutions agreed to participate&#44; including hospitals from the 3 levels of complexity existing in our healthcare network&#58; four regional hospitals&#44; six general hospitals and six district hospitals&#46; In each center&#44; a single investigator consecutively included the first 20 eligible&#44; nonsurgical patients who had been discharged &#40;or exitus&#41; from internal medicine since the start of the study&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The inclusion criteria were an age &#8805;18 years and consent to participate in the study&#46; The exclusion criteria were hospitalization for VTE&#44; undergoing chronic anticoagulation therapy prior to hospitalization&#44; hypersensitivity to low-molecular-weight heparins &#40;LMWHs&#41;&#44; history of heparin-induced thrombocytopenia&#44; active hemorrhaging in the 3 months prior to inclusion&#44; severe hepatic function disorder &#40;Child&#8211;Pugh scale B&#41; and known bleeding disorders &#40;activated partial thromboplastin times &#62;60<span class="elsevierStyleHsp" style=""></span>s prior to hospitalization and international normalized ratio &#62;1&#46;5&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The study variables were recorded at discharge in a standardized format based on the patients&#8217; discharge report and medical history&#46; The decision to start thromboprophylaxis and the type of thromboprophylaxis prescribed was&#44; in each case&#44; at the discretion of the clinician responsible for the patients&#8217; care&#46; No active dissemination or implementation activities were conducted for the standards employed &#40;the 2007 PRETEMED guidelines&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The study variables included demographic characteristics &#40;age&#44; sex&#44; weight&#44; height&#44; body mass index&#44; disease for which the patient was hospitalized&#44; length of hospital stay in days&#44; VTE risk factors&#44; triggers&#44; associated medical diseases&#44; drugs and other factors considered in the PRETEMED guidelines&#41;&#59; the 2007 PRETEMED level of adjusted risk at admission and at hospital discharge&#59; and risk factors for hemorrhaging&#44; specifically concomitant treatment with gastro-damaging drugs or antiplatelets&#59; cerebral&#44; gastrointestinal or genitourinary hemorrhaging beyond 3 months prior to inclusion&#59; other organic lesions susceptible to bleeding&#59; uncontrolled arterial hypertension&#59; blood dyscrasia&#44; hemophilia&#59; and active gastroduodenal ulceration&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">As outcome variables&#44; we measured the prescription of thromboprophylaxis with &#40;a&#41; physical measures&#44; e&#46;g&#46; elastic compression stockings and intermittent pressure therapy&#59; and &#40;b&#41; LMWHs &#40;type&#44; dosage&#44; duration&#41;&#44; at admission and at discharge&#46; We also measured the appropriateness of thromboprophylaxis compared with the 2007 PRETEMED standard&#44; which is classified as underutilization &#40;absence of drug thromboprophylaxis in probands with risk &#8805;4&#41;&#44; overutilization &#40;use of drug thromboprophylaxis in probands with risk &#60;4&#41;&#44; appropriate use &#40;use of drug thromboprophylaxis in probands with risk &#8805;4 or the non-use of drug thromboprophylaxis in patients with risk &#60;4&#41;&#44; and all-cause inhospital mortality&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">For the descriptive study&#44; the quantitative variables are expressed as measures of central tendency and dispersion &#40;mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation&#41;&#44; and the qualitative variables are expressed as frequencies&#46; For the bivariate analysis&#44; we used the chi-squared distribution&#46; The level of statistical significance was established at a value of <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#46; The statistical analysis was performed using the IBM statistical bundle SPSS version 19&#46;0&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall">During the study period&#44; a total of 304 patients were included&#46; Of these&#44; 11 were excluded&#44; in 9 cases for not meeting one of the inclusion&#47;exclusion criteria and in 2 for not specifying whether they met the criteria&#59; these patients were considered lost values&#46; The definitive analysis was conducted with 293 patients&#46; The all-cause hospital mortality was 2&#46;7&#37; &#40;8 patients&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The complete relationship of VTE risk factors is shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; The most common risk factors were an age &#62;60 years and being bed-ridden for more than 4 days&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">The calculation for the weighted risk of VTE on admission &#40;according to the PRETEMED guideline&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2A</a>&#41; showed that 43&#46;4&#37; of the patients &#40;126 participants&#41; had a low risk &#40;RA<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>4&#41;&#44; 8&#46;3&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>24&#41; had a moderate risk &#40;RA<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#41; and the remaining 48&#46;1&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>139&#41; had a high risk &#40;RA<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>4&#41;&#46; Similarly&#44; at hospital discharge &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 2B</a>&#41;&#44; 58&#46;5&#37; of the patients &#40;141 participants&#41; had a low risk&#44; 10&#46;4&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>25&#41; had a moderate risk and the remaining 31&#46;1&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>75&#41; had a high risk&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">On admission and discharge&#44; thromboprophylaxis with LMWHs was prescribed for 265 patients &#40;91&#46;7&#37;&#41; and 49 patients &#40;17&#46;3&#37;&#41;&#44; respectively&#46; The analysis of the appropriateness of thromboprophylaxis to the recommendations of the PRETEMED guidelines&#44; both at admission and at discharge is shown in <a class="elsevierStyleCrossRefs" href="#tbl0010">Tables 2A and 2B</a>&#46; On admission&#44; the rates of underutilization&#44; overutilization and appropriate use of LMWHs according to the 2007 PRETEMED criteria were 1&#46;7&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#41;&#44; 38&#46;4&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>111&#41; and 59&#46;9&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>173&#41;&#44; respectively&#46; On discharge&#44; these rates were 19&#46;9&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>48&#41;&#44; 5&#46;4&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>13&#41; and 74&#46;7&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>180&#41;&#44; respectively&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">In terms of risk factors for hemorrhage&#44; 34&#46;8&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>101&#41; had 1 risk factor&#44; 7&#46;6&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>22&#41; had 2 and 1&#37; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#41; had 3 or more&#46; The most common risk factor for hemorrhage was the concomitant use of gastro-damaging drugs or antiplatelets &#40;32&#46;8&#37;&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Of the 265 patients who were prescribed thromboembolic prophylaxis with LMWHs on admission&#44; 226 &#40;78&#46;5&#37;&#41; were treated with enoxaparin at a dosage of 40<span class="elsevierStyleHsp" style=""></span>mg&#47;24<span class="elsevierStyleHsp" style=""></span>h and 39 &#40;13&#46;5&#37;&#41; were treated with bemiparin at a dosage of 3500 UI&#47;24<span class="elsevierStyleHsp" style=""></span>h&#46; On admission&#44; other antithrombotic measures such as elastic stockings and intermittent pressure therapy were not used&#46; On discharge&#44; 49 patients were treated with LMWHs&#46; Treatment with elastic stockings was prescribed for only 1 case&#44; and none of the cases employed intermittent pressure therapy&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">The analysis of the variables related to the appropriateness on admission is shown in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 3</a>&#46; There was no statistical association for the appropriateness by sex&#46; The appropriateness was less among the younger patients&#44; with lower hemorrhagic risk and with no triggers of acute organ disease or infection&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0100" class="elsevierStylePara elsevierViewall">This multicenter study describes for the first time the risk of VTE in a region of Spain for patients hospitalized for medical diseases and assesses the appropriateness of prescribed thromboprophylaxis to a standard based on scientific evidence&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">We found that only 56&#46;4&#37; of the patients had a moderate to high risk of VTE on admission&#44; while 91&#46;7&#37; were treated with thromboprophylaxis&#44; despite 8&#46;6&#37; of the patients having a considerable risk of hemorrhage &#40;2 or more factors&#41;&#46; At hospital discharge&#44; 41&#46;5&#37; of the patients had a risk of VTE but only 17&#46;3&#37; were treated with thromboprophylaxis&#46; These results reveal a panorama of poor appropriateness due to the overutilization of prophylaxis with LMWHs in 38&#46;4&#37; of the hospitalized patients and in 5&#46;4&#37; at discharge&#46; At the same time&#44; underutilization of thromboprophylaxis was detected in 1&#46;7&#37; and 19&#46;9&#37; of patients at admission and at discharge&#44; respectively&#44; with 14&#46;8&#37; of patients having greater inappropriateness of thromboprophylaxis during their hospital admission&#46; An age less than 60 years and a low risk of bleeding are the main factors that explain the inappropriateness&#44; with the resulting increase in overutilization&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Our findings should be viewed in the context of the disease burden represented by VTE in hospitalized patients&#44; with higher mortality and complications than in surgical patients&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> Spanish epidemiological data show the progressive increase in VTE during hospitalization for a medical disease&#44; reaching 35&#37; of patients diagnosed with VTE between 1999 and 2003&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> despite the preventable nature of VTE&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#8211;14</span></a></p><p id="par0230" class="elsevierStylePara elsevierViewall">The Agency for Healthcare Research and Quality considers thromboprophylaxis one of the most effective safety measures for patients who are hospitalized&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Several studies have evaluated the impact of the recommendations of clinical practice guidelines on the appropriateness of thromboprophylaxis for patients admitted for medical diseases&#46; The ENDORSE project&#44; a study performed between 2006 and 2007 at hospitals in 32 countries that used the risk criteria of the American College of Chest Physicians &#40;ACCP&#41;&#44; showed similar data to those of our study&#44; in which thromboprophylaxis in conditions of high risk is only used in 58&#37; of surgical patients and in 39&#46;5&#37; of medical patients&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> In the analysis of the subgroup of Spanish participants&#44; thromboprophylaxis is significantly superior&#46; However&#44; more than 35&#37; of the evaluated Spanish medical patients were not treated with appropriate prophylaxis&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">There have been several single-center studies in Spain with a limited number of patients<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#8211;22</span></a> that have confirmed the inappropriateness of thromboprophylaxis in hospitalized nonsurgical patients&#46; The study performed at Hospital Carlos Haya compared the appropriateness versus two different standards&#44; the criteria of the PRETEMED guidelines and those of ACCP&#46; They found that in both situations the inappropriateness was greater than 25&#37;&#44; showing that the PRETEMED guidelines overestimate the risk of VTE&#44; when compared with the ACCP guidelines&#44; which demonstrates the need to intensify efforts to stratify the risk of VTE in medical patients&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">In the Andalusian hospitals of our study&#44; 47&#46;8&#37; of the patients who were admitted for medical diseases had a PRETEMED score with a potentially high or very high risk of developing VTE &#40;more than 40&#37; patient&#47;year&#41;&#46; This rate is slightly higher than the 41&#46;5&#37; of medical patients at risk recorded in the ENDORSE study<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> but lower than the 55&#46;1&#37; of patients in the CURVE study in 29 Canadian hospitals&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> Given that the risk stratification in both studies was conducted according to the criteria of the ACCP guidelines&#44; the observed differences could be due to the greater imprecision of the criteria for assessing the risk with this guide&#44; given that the demographic differences of the patients included in these studies &#40;mean age slightly higher than that recorded in the ENDORSE study &#91;69 vs&#46; 67 years&#93; and lower presence of women &#91;42&#46;2&#37; vs&#46; 49&#37;&#93;&#41; do not seem to explain the differences in the proportion of patients at risk&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">In the multinational ENDORSE study&#44; the appropriateness rate for thromboprophylaxis at admission for medical patients was less than that in our study &#40;39&#46;5&#37; vs&#46; 59&#46;9&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">In the subanalysis of data from the Spanish participants of the ENDORSE study&#44; the proportion of medical patients at risk of VTE who were treated with prophylaxis at admission was 64&#37;&#44; a value that is among the highest when compared with the other countries participating in the ENDORSE study&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> In our study&#44; however&#44; the patients at high risk were treated with appropriate thromboprophylaxis in 96&#46;4&#37; of the cases&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">In our study&#44; the prophylaxis of VTE was performed almost exclusively with LMWHs&#44; both at admission and at hospital discharge&#44; a similar situation to that described in the ENDORSE study&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> For 19 patients &#40;8&#37; of those included in the study&#41;&#44; the heparin dosage used was insufficient&#59; 10 of these patients also had no indication for prophylaxis&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Regarding the use of physical measures for mechanical prophylaxis&#44; only 1 patient was prescribed elastic compression at discharge&#44; and none of the patients underwent intermittent pressure therapy &#40;either at admission or discharge&#41;&#44; even patients at low to medium risk of VTE&#46; These results are lower than those registered in other studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;22</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">Various strategies have been proposed for improving the appropriateness of thromboprophylaxis for hospitalized medical patients&#44; with results that improve the underutilization in high-risk patients but do not improve overall appropriateness&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;24</span></a> Surgery implemented according to the PRETEMED guidelines&#44; with electronic alerts&#44; reduced the number of cases of VTE during hospitalization &#40;OR&#44; 0&#46;36&#59; 95&#37; CI 0&#46;12&#8211;0&#46;98&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">The limitations of the study include the representativeness of the sample&#46; Although almost half of the institutions of the Andalusian hospital network participated in the study and the inclusion of patients was random&#44; as well as the fact that we excluded a number of diseases with high hemorrhagic risk&#44; we cannot fully ensure that the sample was representative of the overall population of hospitalized medical patients and that the results can be extrapolated to hospitalized patients in other medical areas&#46; Another limitation of our study is the possible observation bias&#44; given that the researchers knew of their participation in the study and used a data collection notebook&#44; which could have influenced the therapeutic management by these practitioners&#46; The study protocol did&#44; however&#44; clearly specify that it was up to the researcher&#39;s discretion whether to indicate thromboembolic prophylaxis or not&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Despite these limitations&#44; it should be noted that our study is the first to analyze the appropriateness of thromboprophylaxis at discharge&#44; given that VTE affects both hospitalized patients and outpatients&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Our data are consistent with those of other studies that indicate the prescription of thromboprophylaxis as an area of improvement for hospitalized nonsurgical patients&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> In particular&#44; our study observed an overutilization that suggests that thromboprophylaxis is prescribed almost routinely&#44; despite the risks&#44; cost and disadvantages it entails&#46; The use of evidence-based CPGs could therefore help improve the appropriateness of prescribed prophylaxis&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">In short&#44; the present multicenter study has helped confirmed that&#44; in Andalusia&#44; patients hospitalized in internal medicine units have a high risk of venous thromboembolism and that the use of thromboprophylaxis with LMWHs is practically routine during admission&#44; regardless of the risk threshold of VTE&#46; This identifies high inappropriateness due to overutilization of thromboprophylaxis during admission and underutilization at discharge&#46; This situation can be corrected through specific interventions to facilitate the identification of VTE risk&#44; followed by the application of the recommended prophylaxis that results in the greatest benefit and least harm&#46;<elsevierMultimedia ident="tb0005"></elsevierMultimedia></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Funding</span><p id="par0190" class="elsevierStylePara elsevierViewall">The study was conducted with partial financial help from Sanofi-Aventis and institutional support from the <span class="elsevierStyleGrantSponsor" id="gs1">Andalusian Internal Medicine Society</span> &#40;<span class="elsevierStyleItalic">Sociedad Andaluza de Medicina Interna</span>&#44; SADEMI&#41;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflicts of interest</span><p id="par0195" class="elsevierStylePara elsevierViewall">The authors declare that the study received partial funding from Sanofi-Aventis for logistical support in the distribution and collection of case report forms&#46;</p></span></span>"
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            2 => "Clinical guidelines"
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            0 => "Profilaxis"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Hospitalized patients are a population at risk for venous thromboembolism &#40;VTE&#41;&#46; The PRETEMED-2007 clinical practice guidelines help identify high-risk medical patients who are suited to thromboprophylaxis&#46; These guidelines therefore <span class="elsevierStyleItalic">provide a standard for prophylaxis in such patients</span>&#46; We evaluated the risk of VTE and the adjustment of thromboprophylaxis to the standards of the PRETEMED-2007 guidelines in patients hospitalized in internal medicine departments&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">An observational&#44; cross-sectional multicenter study was performed in 2010 in 16 hospitals in Andalusia and included 20 consecutive patients per center&#46; The study variables were age&#44; sex&#44; risk factors for VTE and hemorrhage&#44; the risk-adjusted PRETEMED of VTE&#44; adjustment of thromboembolic prophylaxis at admission and at discharge and hospital mortality&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The study included 293 patients &#40;57&#46;8&#37; men&#41; with a mean age of 69 &#40;&#177;15&#41; years&#46; The most common triggers for VTE were acute severe infection &#40;27&#46;3&#37;&#41; and neoplasia &#40;16&#46;4&#37;&#41;&#46; Some 43&#46;4&#37; of the patients presented a risk of hemorrhage&#46; The risk of VTE at admission and discharge was high in 47&#46;8&#37; and 31&#37; and moderate in 8&#46;2&#37; and 10&#46;6&#37;&#44; respectively&#46; A total of 91&#46;7&#37; and 17&#46;3&#37; of the patients underwent prophylaxis with low-molecular-weight heparin on admission and at discharge&#44; respectively&#46; The prescription was appropriate for 59&#46;9&#37; of the patients at admission &#40;overutilization 38&#46;4&#37;&#44; underutilization 1&#46;7&#37;&#41; and for 74&#46;7&#37; at discharge &#40;overutilization 5&#46;4&#37;&#44; underutilization 19&#46;9&#37;&#41;&#46; The adjustment was greater in patients older than 60 years and with greater hemorrhagic risk&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">For 60&#37; of the patients admitted to the departments of internal medicine in Andalusia&#44; the thromboprophylaxis was appropriate&#46; The inadequacy of thromboprophylaxis &#40;40&#37;&#41; is mostly due to overutilization&#46; These results suggest significant space for improvement&#46;</p></span>"
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            "titulo" => "Patients and methods"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes y objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Los pacientes hospitalizados constituyen una poblaci&#243;n de riesgo para la enfermedad tromboemb&#243;lica venosa &#40;ETV&#41;&#46; La gu&#237;a de pr&#225;ctica cl&#237;nica PRETEMED-2007 permite identificar a los pacientes m&#233;dicos de alto riesgo susceptibles de tromboprofilaxis&#44; y as&#237; <span class="elsevierStyleItalic">disponer de un est&#225;ndar de profilaxis en tales pacientes</span>&#46; Hemos evaluado el riesgo de ETV y la adecuaci&#243;n de tromboprofilaxis a los est&#225;ndares de la gu&#237;a PRETEMED-2007 en los pacientes hospitalizados en servicios de medicina interna&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional transversal y multic&#233;ntrico realizado en 2010 en 16 hospitales de Andaluc&#237;a que incluyen 20 pacientes consecutivos por centro&#46; Variables&#58; edad&#44; sexo&#44; factores de riesgo de ETV y hemorragia&#44; riesgo ajustado PRETEMED de ETV&#44; adecuaci&#243;n de profilaxis tromboemb&#243;lica al ingreso y al alta y mortalidad intrahospitalaria&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 293 pacientes &#40;57&#44;8&#37; varones&#44; edad media de 69<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15 a&#241;os&#41;&#46; Los factores precipitantes de ETV m&#225;s frecuentes fueron&#58; infecci&#243;n aguda grave &#40;27&#44;3&#37;&#41; y neoplasia &#40;16&#44;4&#37;&#41;&#46; El 43&#44;4&#37; presentaba riesgo de hemorragia&#46; El riesgo de ETV al ingreso y alta fue elevado en el 47&#44;8 y 31&#37; y moderado en el 8&#44;2 y 10&#44;6&#37; respectivamente&#46; Recibieron profilaxis con heparina de bajo peso molecular el 91&#44;7&#37; al ingreso y el 17&#44;3&#37; al alta&#46; La prescripci&#243;n fue adecuada en el 59&#44;9&#37; al ingreso &#40;sobreuso 38&#44;4&#37;&#44; infrauso 1&#44;7&#37;&#41; y en el 74&#44;7&#37; al alta &#40;sobreuso 5&#44;4&#37;&#44; infrauso 19&#44;9&#37;&#41;&#46; La adecuaci&#243;n fue mayor en pacientes mayores de 60 a&#241;os y con mayor riesgo hemorr&#225;gico&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">En el 60&#37; de los enfermos que ingresan en los servicios de medicina interna de Andaluc&#237;a la tromboprofilaxis es adecuada&#46; La inadecuaci&#243;n de tromboprofilaxis &#40;40&#37;&#41; es mayoritariamente por sobreindicaci&#243;n&#46; Estos resultados sugieren un amplio campo de mejora&#46;</p></span>"
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            "titulo" => "Antecedentes y objetivos"
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            "titulo" => "Pacientes y m&#233;todos"
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            "titulo" => "Resultados"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0040">Please cite this article as&#58; Navarro Puerto MA&#44; Medrano Ortega FJ&#44; Izquierdo Guerrero R&#44; Calder&#243;n Sandubete E&#44; Buz&#243;n-Barrera ML&#44; Mar&#237;n-Le&#243;n I&#44; et al&#46; Adecuaci&#243;n de tromboprofilaxis en pacientes m&#233;dicos hospitalizados en Andaluc&#237;a&#46; Estudio multic&#233;ntrico&#46; Rev Clin Esp&#46; 2015&#59;215&#58;141&#8211;147&#46;</p>"
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            "apendice" => "<p id="par0210" class="elsevierStylePara elsevierViewall">The PRETEMED COLLABORATIVE GROUP consisted of the following physicians from the departments of internal medicine at the participating hospitals&#58; regional hospitals&#58; I&#46; Mart&#237;n Garrido from Hospital Virgen del Roc&#237;o and J&#46;C&#46; San Gonz&#225;lez from Hospital Virgen Macarena &#40;Seville&#41;&#44; M&#46;A&#46; Blanco Molina from Hospital Reina Sof&#237;a &#40;Cordoba&#41;&#44; Hospital Virgen de las Nieves &#40;Granada&#41;&#59; general hospitals&#58; R&#46; G&#243;mez Herrero&#44; R&#46; Gonz&#225;lez Ferrer from Hospital Valme &#40;Sevilla&#41;&#44; F&#46; Mu&#241;oz Beamud&#44; J&#46;J&#46; Cordero Soriano&#44; M&#46;J&#46; Marchena Gonz&#225;lez from Hospital Juan Ram&#243;n Jim&#233;nez &#40;Huelva&#41;&#44; M&#46; Marcos Herrera from Hospital Costa del Sol &#40;Marbella&#44; Malaga&#41;&#44; San Cecilio &#40;Granada&#41;&#44; Hospital Complex of Ja&#233;n &#40;Ja&#233;n&#41;&#44; M&#46;P&#46; Mart&#237;nez Cort&#233;s from Hospital Torrec&#225;rdenas &#40;Almer&#237;a&#41;&#59; and district hospitals&#58; J&#46; &#193;lvarez Suero of Hospital de la Merced &#40;Osuna&#44; Seville&#41;&#44; F&#46; D&#237;az Navarro of Hospital Infanta Elena and J&#46;A&#46; Chac&#243;n Serrano of Hospital Riotinto &#40;Huelva&#41;&#44; R&#46; Tirado Miranda of Hospital Infanta Margarita &#40;Cabra&#44; Cordoba&#41;&#44; J&#46;N&#46; Alcal&#225; Pedrajas of Hospital Valle de los Pedroches &#40;Pozoblanco&#44; Cordoba&#41; and G&#46; Ojeda Burgos of Hospital Xanit &#40;Malaga&#41;&#46;</p>"
            "etiqueta" => "Appendix A"
            "titulo" => "&#91;&#123;&#40;Annex&#41;&#125;&#93;"
            "identificador" => "sec0045"
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          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The weight adjusted according to PRETEMED-2007 is shown in the parentheses&#46;</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; COPD&#44; chronic obstructive pulmonary disease&#59; DVT&#44; deep vein thrombosis&#59; HIV&#44; human immunodeficiency virus&#59; SD&#44; standard deviation&#59; SVT&#44; superficial venous thrombosis&#46;</p>"
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Triggering processes</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Severe acute infection &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Neoplasia &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>COPD with severe decompensation &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Class III heart failure &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Acute stroke with lower limb paralysis &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Class IV heart failure &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Acute myocardial infarction &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Lower limb trauma without surgery &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Active inflammatory bowel disease &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Airplane flights &#62;6<span class="elsevierStyleHsp" style=""></span>h &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Processes associated with medical disease</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Diabetes mellitus &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Lower limb paralysis &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Previous DVT &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Previous SVT &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>HIV infection &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Nephrotic syndrome &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Vasculitis &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Use of drugs</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Antidepressants &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Antipsychotics &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Chemotherapy &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Tamoxifen&#8211;Raloxifene &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hormonal contraceptives &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">Other factors</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Female sex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">124&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mean age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mean BMI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mean stay&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Age &#62;60<span class="elsevierStyleHsp" style=""></span>years &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">216&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Bed rest &#62;4<span class="elsevierStyleHsp" style=""></span>days &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">139&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Obesity &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Smoking &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Central venous catheter &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Clinical characteristics and risk factors for venous thromboembolism in the study population&#46;</p>"
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      1 => array:7 [
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        "etiqueta" => "Table 2A"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Values without asterisks indicate adequate practice&#46;</p><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; LMWH&#44; low-molecular-weight heparins&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">PRETEMED risk at admission</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#60;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#62;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Prophylaxis with LMWH&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">111 &#40;38&#46;4&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20 &#40;6&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">134 &#40;46&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;5&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;1&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;1&#46;7&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Total<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">126 &#40;43&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24 &#40;8&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">139 &#40;48&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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            1 => array:3 [
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Adequacy of thromboprophylaxis with low-molecular-weight heparins according to PRETEMED at admission&#46;</p>"
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          "leyenda" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Values without asterisks indicate adequate practice&#46;</p><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; LMWH&#44; low-molecular-weight heparins&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">PRETEMED risk at discharge</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#60;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#62;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13 &#40;5&#46;4&#41;<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;1&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27 &#40;11&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">128 &#40;53&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21 &#40;8&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48 &#40;19&#46;9&#41;<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Total<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">141 &#40;58&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25 &#40;10&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75 &#40;31&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Heart disease&#58; class III and IV heart failure of the New York Heart Association classification and&#47;or acute myocardial infarction&#46;</p><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">COPD&#44; chronic obstructive pulmonary disease&#59; acute stroke&#44; acute stroke with paralysis of the lower limbs&#59; RF&#44; risk factors&#46;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Adequate<span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Inadequate<span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span><a class="elsevierStyleCrossRef" href="#tblfn0040"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Sex</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">163&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">96 &#40;58&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">67 &#40;41&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;743&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">120&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73 &#40;60&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47 &#40;39&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Age &#62;60 years</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">213&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">140 &#40;65&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73 &#40;34&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33 &#40;43&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43 &#40;56&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Age</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#62;85 years</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23 &#40;63&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13 &#40;36&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;598&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">253&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">150 &#40;59&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">103 &#40;40&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Infection</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70 &#40;87&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;12&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">209&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">103 &#40;49&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">106 &#40;50&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Heart disease</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42 &#40;87&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;12&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">241&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">131 &#40;54&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">110 &#40;45&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Neoplasia</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35 &#40;74&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;25&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;026&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">242&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">138 &#40;57&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">104 &#40;43&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">COPD</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28 &#40;90&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;9&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">258&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">145 &#40;56&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">113 &#40;43&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Acute stroke</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">275&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">159 &#40;57&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">116 &#40;42&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">&#8805;2 RFs for hemorrhage</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20 &#40;80&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;20&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;031&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">261&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">151 &#40;57&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">110 &#40;42&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">What we know&#63;</span><p id="par0175" class="elsevierStylePara elsevierViewall">VTE is a common and preventable disease in hospital settings for patients treated either by surgical or medical departments&#46; The PRETEMED 2007 guidelines help calculate the risk of VTE and offers recommendations based on rigorous clinical studies&#46; This study analyzes the adequacy of thromboprophylaxis in patients hospitalized in the departments of internal medicine of 16 hospitals in Andalusia&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">What this article provides&#63;</span><p id="par0180" class="elsevierStylePara elsevierViewall">Almost half of approximately 300 patients &#40;mean age of 69 years&#41; had a high risk of VTE at admission&#44; which decreased to 30&#37; by the time the patients were discharged&#46; Thromboprophylaxis was adequate in 60&#37; and 75&#37; of cases at admission and discharge&#44; respectively&#46; The inadequacy of thromboprophylaxis was mostly due to overindication&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">The Editors</p></span></span>"
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                          "etal" => true
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                            1 => "G&#46; Agnelli"
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                          "colaboracion" => "Thromboembolic Pulmonary Hypertension Study Group"
                          "etal" => true
                          "autores" => array:6 [
                            0 => "V&#46; Pengo"
                            1 => "A&#46;W&#46; Lensing"
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                            0 => "R&#46; Collins"
                            1 => "A&#46; Scrimgeour"
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                            0 => "M&#46;M&#46; Samama"
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                          "etal" => false
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                            0 => "A&#46; Leizorovicz"
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                            3 => "C&#46;G&#46; Olsson"
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        "texto" => "<p id="par0205" class="elsevierStylePara elsevierViewall">The study was approved by the Research Ethics Committee of University Hospital Valme of Seville&#46;</p> <p id="par0225" class="elsevierStylePara elsevierViewall">We would like to thank SADEMI&#44; and specifically its president at the time the study was conducted &#40;Dr&#46; Alfredo Mich&#225;n&#41;&#44; who collaborated in the recruitment of participating departments&#46;</p>"
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Article information

ISSN: 22548874
Original language: English

DOI:10.1016/j.rceng.2014.09.002

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