The Incidence of Clinical Venous Thromboembolism and Use of Ambulatory Prophylaxis Methods in Bedridden Acutely Ill Medical Outpatients: The ETAPE Study.

Introduction Venous thromboembolism (VTE) prophylaxis in hospitalized acutely ill medical patients has become more commonly used in France, especially since the results of the MEDENOX study (

Methods Patients ≥40 years, with an acute medical illness leading to reduced mobility ≥48 h and justifying a medical visit at the patients’ home, were consecutively included in this prospective, multicenter, epidemiological study. Exclusion criteria were: reduced mobility due to a surgical procedure, reduced mobility for >1 month, or use of anticoagulant prior to enrollment. The primary outcome measure was the incidence of clinical deep-vein thrombosis (DVT) between days 1 and 21. The secondary outcome was the incidence of VTE (DVT or pulmonary embolism [PE]). Patients were enrolled by 2895 general practitioners, randomly drawn from a database of 25520 physicians.

Results Of 17194 patients enrolled, 16532 (96.1%) were evaluable. Patients’ median age was 71 years, 61% were female, and 13% were totally bedridden. Patients had one or more of the following medical conditions: hypertension (39%), venous insufficiency of lower limbs with varicose veins (30%), severe infection (29%), acute rheumatologic episode (27%), and diabetes (15%). Patients’ medical histories included prior DVT (14%), cardiac failure (12%), cancer (9%), and myocardial infarction and stroke (5%). Overall, 35% of patients received VTE prophylaxis. Of enrolled patients, 18% were considered to be at major risk, 25% moderate risk, and 57% low risk for VTE based on classical risk factors for VTE described in published guidelines on VTE prevention. Of these patients, 56%, 38% and 27% received prophylaxis, respectively. The incidences of clinical DVT were 1.9%, 0.9% and 0.7%, in patients at major, moderate or low risk for DVT, respectively. A summary of VTE events at follow-up is shown in Table 1.

Conclusion The incidence of clinical VTE (1.1%) observed in this population is similar to that observed in orthopedic surgery patients (1.3–3.3%;

Table 1. Incidence of clinical VTE events at follow-up