Profilaxia para tromboembolia venosa em um hospital geral

Fuzinatto, Fernanda; Wajner, André; Waldemar, Fernando Starosta de; Hopf, João Luiz de Souza; Schuh, Juliana Ferro; Barreto, Sérgio Saldanha Menna

doi:10.1590/s1806-37132011000200005

Cited by 10 publications

(17 citation statements)

References 27 publications

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“…The mean number of risk factors observed in patients in all of the different study population strata confirms the ACCP's VTE prevention statement that almost all hospitalized patients have at least one risk factor for VTE. 5 The low prevalence of patients with contraindications against chemoprophylaxis is also similar to other authors' results 17 and shows that administration is safe.…”

Section: Discussionsupporting

confidence: 85%

“…The profile of the patients admitted, in terms of the proportions of clinical (62%) and surgical patients (38%), was no different to what has been observed at other general hospitals, 10,17 although patient risk stratification profiles do vary greatly at different institutions. Coexistence of several different guidelines, differences between patient profiles and, possibly, non-uniform analysis methods may be responsible for differences in the results reported by different authors.…”

Section: Discussionmentioning

confidence: 58%

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Avaliação da profilaxia da trombose venosa profunda em um hospital geral

2018

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Background: Venous thromboembolism (VTE) is a cause for growing concern in hospitals, has great impact on morbidity and mortality in clinical and surgical patients, and is the leading cause of preventable hospital deaths. Although there are risk assessment models for hospital inpatients, prophylaxis is still underused or is administered incorrectly. Objectives: To assess the risk profile for VTE in recently hospitalized clinical and surgical patients and evaluate the thromboprophylactic measures implemented in the first 24 hours of hospitalization. Methods: Cross-sectional study conducted in a large general hospital in the state of São Paulo, Brazil, between March and July 2015. Padua and Caprini scores were used for risk stratification of clinical and surgical patients, respectively, while thromboprophylactic measures were analyzed for compliance with the recommendations contained in the 8th and 9th Consensus of the American College of Chest Physicians. Results: A total of 592 patients (62% clinical and 38% surgical) were assessed. Risk stratification revealed a need for chemoprophylaxis in 42% of clinical patients and 81% of surgical patients (51% high risk and 30% moderate risk). However, 54% of high-risk clinical patients, 85% of high-risk surgical patients, and 4% of moderate-risk surgical patients, who were free from contraindications, were actually given the correct prophylaxis in the first 24 hours of hospitalization. Conclusions: There is a need to improve patient safety in relation to VTE in the first hours of hospitalization, since there is underutilization of chemoprophylaxis, especially in high-risk clinical patients and moderate-risk surgical patients. ResumoContexto: O tromboembolismo venoso (TEV) representa uma preocupação crescente nas instituições hospitalares, tem grande impacto sobre a morbimortalidade em pacientes clínicos e cirúrgicos, e é a principal causa de morte evitável hospitalar. Embora existam modelos de avaliação de risco para pacientes hospitalizados, a profilaxia ainda é subutilizada ou é feita de forma incorreta. Objetivos: Avaliar o perfil de risco para TEV de pacientes clínicos e cirúrgicos recém-internados, bem como as medidas tromboprofiláticas aplicadas nas primeiras 24 horas de internação. Métodos: Este estudo transversal foi realizado em um hospital geral de grande porte do interior do estado de São Paulo entre março e julho de 2015. Os escores de Pádua e Caprini foram utilizados para estratificação de risco dos pacientes clínicos e cirúrgicos, respectivamente, enquanto a análise das medidas tromboprofiláticas baseou-se nas recomendações do 8º e 9º Consenso do American College of Chest Physicians. Resultados: Foram analisados 592 pacientes (62% clínicos e 38% cirúrgicos). A estratificação de risco revelou necessidade de quimioprofilaxia em 42% dos pacientes clínicos e 81% dos cirúrgicos (51% de alto risco e 30% de moderado risco). Por outro lado, receberam profilaxia adequada nas primeiras 24 horas de internação 54% dos pacientes clínicos de alto risco, 85% dos cirúrgicos ...

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 58%

Avaliação da profilaxia da trombose venosa profunda em um hospital geral

2018

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“…The present study involves several Institutions with different case mix of patients. Data of previously published studies from Latin america have shown that 60 to 80% of hospitalized patients belong to moderate to high risk of VTE categories [14,15]. …”

Section: Methodsmentioning

confidence: 99%

Risk of venous thromboembolic disease and adequacy of prophylaxis in hospitalized patients in Argentina: a multicentric cross-sectional study

Vazquez

Watman²,

Tabares

et al. 2014

Thrombosis Journal

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BackgroundVenous thromboembolic disease (VTE) is associated with high morbi-mortality. Adherence rate to the recommendations of antithrombotic prophylaxis guidelines (ATPG) is suboptimal. The aim of this study was to describe the adequacy of antithrombotic prophylaxis (ATP) in hospitalized patients as the initial stage of a program designed to improve physician adherence to –ATP recommendations in Argentina.MethodsThis study was a multicenter, cross-sectional study that included 28 Institutions throughout 5 provinces in Argentina.Results1315 patients were included, 729 (55.4%) were hospitalized for medical (clinical) reasons, and 586 (44.6%) for surgical reasons. Adequate ATP was provided to 66.9% of the patients and was more frequent in surgical (71%) compared to clinical (63.6%) subjects (p < 0.001). Inadequate ATP resulted from underuse in 76.6% of the patients. Among clinical, 203 (16%) had increased bleeding risk and mechanical ATP was used infrequently.ConclusionsThe adequacy of ATP was better in low VTE risk clinical and surgical patients and high VTE risk in orthopedic patients. There was worse adequacy in high risk patients (with active neoplasm) and in those with pharmacological ATP contraindications, in which the use of mechanical methods was scarce. The adequacy of ATP was greater at institutions with < 150 beds compared with larger institutions. This is the first multicentric study reporting ATP in Argentina. Understanding local characteristics of medical performance within our territory is the first step in order to develop measures for improving ATP in our environment.

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“…( 15 ) Each prescription was classified as appropriate or inappropriate on the basis of whether it followed the protocol, after considering the patient risk of VTE and the presence of contraindications to heparin. Two of the authors assessed the appropriateness of prophylaxis, and questionable cases were discussed by the research group as a whole.…”

Section: Methodsmentioning

confidence: 99%

A clinical decision support system for venous thromboembolism prophylaxis at a general hospital in a middle-income country

Fuzinatto¹,

Waldemar²,

Wajner³

et al. 2013

J. bras. pneumol.

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OBJECTIVE: To determine the impact that implementing a combination of a computer-based clinical decision support system and a program of training seminars has on the use of appropriate prophylaxis for venous thromboembolism (VTE). METHODS: We conducted a cross-sectional study in two phases (prior to and after the implementation of the new VTE prophylaxis protocol) in order to evaluate the impact that the combined strategy had on the use of appropriate VTE prophylaxis. The study was conducted at Nossa Senhora da Conceição Hospital, a general hospital in the city of Porto Alegre, Brazil. We included clinical and surgical patients over 18 years of age who were hospitalized for ≥ 48 h. The pre-implementation and post-implementation phase samples comprised 262 and 261 patients, respectively. RESULTS: The baseline characteristics of the two samples were similar, including the distribution of patients by risk level. Comparing the pre-implementation and post-implementation periods, we found that the overall use of appropriate VTE prophylaxis increased from 46.2% to 57.9% (p = 0.01). Looking at specific patient populations, we observed that the use of appropriate VTE prophylaxis increased more dramatically among cancer patients (from 18.1% to 44.1%; p = 0.002) and among patients with three or more risk factors (from 25.0% to 42.9%; p = 0.008), two populations that benefit most from prophylaxis. CONCLUSIONS: It is possible to increase the use of appropriate VTE prophylaxis in economically constrained settings through the use of a computerized protocol adhered to by trained professionals. The underutilization of prophylaxis continues to be a major problem, indicative of the need for ongoing improvement in the quality of inpatient care.

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Profilaxia para tromboembolia venosa em um hospital geral

Cited by 10 publications

References 27 publications

Avaliação da profilaxia da trombose venosa profunda em um hospital geral

Avaliação da profilaxia da trombose venosa profunda em um hospital geral

Risk of venous thromboembolic disease and adequacy of prophylaxis in hospitalized patients in Argentina: a multicentric cross-sectional study

A clinical decision support system for venous thromboembolism prophylaxis at a general hospital in a middle-income country

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