[Venous thromboembolism in the elderly: Results of a program to improve prevention]
Résumé
INTRODUCTION: Venous thromboembolism is highly prevalent in the elderly population. However, this age group often receives inadequate thromboprophylaxis because of concerns about bleeding risk, denying patients the benefit of proven antithrombotic regimens. Besides, there is a lack of data in non-surgical patients in postacute care facilities. METHODS: A multifaceted intervention program addressing venous thromboembolism prophylaxis has been conducted and evaluated in 50 postacute care facilities. Data were collected in two cross-sectional, epidemiologic studies of 1664 patients aged 65 years or older, including a systematic venous complete compression ultrasound. RESULTS: Despite the fact that 56% of patients received pharmacologic prophylaxis, the prevalence of asymptomatic deep venous thromboses (DVT) was 15%. Specific risk factors in this population have been identified: dependence in basic activities of daily living (ADLs), a higher timed Up and Go test score and the presence of pressure ulcers. Implantation of a multifaceted program was followed by a reduction in DVT prevalence (OR=0.58, CI95%, 0.40-0.83). Implication of nurses and physical therapists was associated with an increase in patient's mobilization (62% versus 37%, p<0.01). Nevertheless, we were unable to find any efficacy of medical compression in venous thomboembolism prevention for medical patients. CONCLUSION: This project shows the high prevalence of venous thromboembolism in postacute care facilities and enhances the need for a multidisciplinary approach to this disease.