[Pharmacological Thromboprophylaxis in Acutely Ill Hospitalized Medical Patients]. / Thromboprophylaxie pharmacologique chez les patients hospitalisés pour une affection médicale aiguë.

Venous thromboembolic events (VTE) occur in approximately 50% of cases during or following hospitalization; VTE are a major cause of morbidity and mortality. Thromboprophylaxis for 6 to 14 days with heparins or fondaparinux has been demonstrated to be effective in VTE prevention in patients hospitalized for acute medical illnesses and reduced mobility. Nevertheless, the level of recommendation has been gradually downgraded as the benefit has been mainly demonstrated on the basis of systematic imaging diagnosed events. Direct oral anticoagulants have been assessed only as an extended prophylaxis, and are currently not recommended in medical thromboprophylaxis. Assessing the risk of VTE and bleeding in medical patients is complex. VTE and bleeding risk assessment scores were constructed but have not been validated. In order to improve the adequacy of prescriptions for thromboprophylaxis, the impact of different interventions has been the subject of several studies but these yielded varying results. The aim of this review is to analyze the indications for thromboprophylaxis in a medical setting with the latest available data.

Educational diagnosis of patients under oral anticoagulant therapy: Development of a 4-category patient profiling score based on a retrospective study and prospective analysis.

BACKGROUND: Oral anticoagulants are used in numerous pathologies and their consumption is growing. However, to prevent their occurrence, their use should be supervised and the patients educated. Patients vary in understanding and compliance. Therefore, it seems necessary to standardize educational diagnosis with a patient profiling score to adapt therapeutic education to the individual patient profile. METHOD: A retrospective study based on observation of consecutive patients treated by an oral anticoagulant therapy and involved in a therapeutic education program conducted between October 2014 and December 2015. A 12-item questionnaire distinguished 4 profiles based on the educational diagnosis. In a prospective double-blind study including consecutive patients with an indication to anticoagulants and admitted to the Internal Medicine department of the Louis-Mourier Hospital (AP-HP, University of Paris), the patient's profile defined by a clinician using the questionnaire was compared to the one defined by the Therapeutic Education Leader after standardized educational diagnosis. RESULTS: The questionnaire was tested prospectively in 53 patients, 26 of which had also a complete therapeutic education by the TEP leader. In any case, the assessment assisted by the questionnaire succeeded in identifying the patient profile, as determined by the therapeutic education specialist. CONCLUSION: The present questionnaire helps identify different patient profiles and therefore standardize educational diagnosis. The perspective is to adapt therapeutic education to individual patient profile, with the objective to improve compliance.