Appropriateness of Pharmacologic Prophylaxis against Deep Vein Thrombosis in Medical Wards of an Ethiopian Referral Hospital

Abstract

Background Most of hospitalized patents are at risk of developing deep vein thrombosis (DVT). The use of pharmacological prophylaxis significantly reduces the incidence of thromboembolic events in high risk patients. The aim of this study was to assess appropriateness of DVT prophylaxis in hospitalized medical patients in an Ethiopian referral hospital. Methods Cross-sectional study design was employed. Patients with a diagnosis of DVT, taking anticoagulant therapy, and those who refused to participate were excluded from the study. Two hundred and six patients were included in the study using simple random sampling method. Modified Padua Risk Assessment Model was used to determine the risk of thromboembolism. SPSS (version 21) was used for analysis. Result The total risk score for the study subjects ranged from 0 to 11 with a mean score of 3.41 ± 2.55. Nearly half (47.6%) of study participants had high risk to develop thromboembolism. Thrombocytopenia (platelets < 50 billion/L) or coagulopathy, active hemorrhage, and end stage liver disease (INR > 1.5) were the frequently observed absolute contraindications that potentially prevent patients from receiving thromboprophylaxis. Thromboprophylaxis use in nearly one-third (31.6%) of patients admitted in the medical ward of UoGRH was irrational. Patients who had high risk for thromboembolism are more likely to be inappropriately managed for their risk of thromboembolism and patients with thrombocytopenia or coagulopathy were more likely to be managed appropriately. Conclusion There is underutilization of pharmacologic thromboprophylaxis in medical ward patients. Physicians working there should be aware of risk factors for DVT and indications for pharmacologic thromboprophylaxis and should adhere to guideline recommendations.

Incidence of thromboembolism and thromboprophylaxis in medical patients admitted to specialized hospital in Ethiopia using Padua prediction score

“…In line with other studies reported from Ethiopia, 23 , 24 in the present study, the most common risk factors for VTE were acute infection/and rheumatologic disorder (76.7%), reduced mobility (41.1%), having heart and /or respiratory failure (21.5%), elderly age ⩾70 years (13.7%), active cancer (10.5%), and acute myocardial infarction or ischemic stroke (12.8%).…”

“…Similarly, another study from Ethiopia reported that about 47.6% of medical inpatients had a significant DVT risk. 24 However, in our study, thromboprophylaxis was given to only 25.1% of patients and 6.84% of them received it without having risk or they were at lower risk which doesn’t mandate thromboprophylaxis and four patients were given pharmacologic prophylaxis despite the patients had absolute contraindication. There were 26 patients from high-risk group who did not get prophylaxis which may be due to ineligibility and/or contraindication, the fear of risk of bleeding and failure of prescribing them even for legible patients by prescribers.…”

Evidence-based perioperative diagnosis and management of pulmonary embolism: A systematic review

“…Deep venous thrombosis (DVT) can be prevented through non-pharmacologic prophylaxis (compression stockings, leg elevation, sequential compression devices (SCDs), ambulation, and vena cava filter) and pharmacologic intervention, which is through the use of blood-thinning medications[ 2 , 11 , 27 ]. The most common blood thinner prophylaxis in Ethiopia is unfractionated heparin (UFH) and warfarin.…”

“…The most common blood thinner prophylaxis in Ethiopia is unfractionated heparin (UFH) and warfarin. The major side effect of blood-thinning medications is an increased risk of bleeding and some patients are contraindicated for blood-thinning medications since they have a greater risk of developing adverse events[ 11 , 24 ]. The overall mortality rate in untreated patients is 30%, with approximately 10% of patients dying within 1 h of the event.…”

“…Pulmonary embolism is a potentially life-threatening condition that needs immediate diagnosis and management [ 9 ], since Surgery puts patients at a fivefold increased risk for pulmonary embolism[ [7] , [8] , [9] ], in addition, perioperative thromboprophylaxis is underutilization in Ethiopian hospital ward patients who have a risk of pulmonary embolism and professionals do not adhere to guideline recommendations[ 11 ].…”