Is guideline-driven prophylaxis for venous thromboembolism common practice in the South African private hospital setting?

Abstract

Background: Prophylactic venous thromboembolism (VTE) strategies have the greatest impact on patient outcomes. Both global and local guidelines support VTE prophylaxis for hospitalised patients. However, studies have reported that these measures are routinely under-prescribed. This study evaluated prescribing patterns of VTE prophylaxis in one of the largest South African (SA) private hospital groups.Methods: A quantitative, retrospective analysis of the hospital group’s patient database was conducted for patients admitted between 01 September 2015 and 31 August 2016. Those younger than 18 years with trauma or suffering from contraindications to anticoagulation were excluded. Additionally, patients with warfarin billed were also excluded as they possibly required therapeutic anticoagulation. Included prophylactic measures were compared with published SA guidelines by abstracting prophylaxis type and dosing, according to corresponding individual patients’ VTE risk ratings.Results: Amongst the 373 020 patients included as the study population, 77% required prophylaxis. Of these, 38.36% (n = 85 486) received guideline-appropriate prophylactic measures during their hospital stay. Patients in whom prophylaxis was indicated, only 24.56% (n = 42 715) complied with the SA guidelines. The most commonly used prophylactic measures were enoxaparin (89.09%) and fondaparinux (2.68%). Prophylactic measures differed per speciality, with the most compliant amongst intensivists. A low uptake of the risk assessment model use (n = 222 860, 59.75%) was, however, reported for this data set.Conclusion: Less than 24.56% of patients who required prophylaxis received guideline-appropriate interventions. Further studies should focus on understanding differences in practice and improving acceptance and application of guideline-driven care.

Venous thromboembolism risk assessment and prophylaxis in hospitalised medical patients in the Cape Town metropole, South Africa

“…guidelines worldwide. [3] The therapeutic practice guideline for VTE developed by the Southern African Society of Thrombosis and Haemostasis closely mirrors the ACCP guideline, which bases VTE risk assessment on the Caprini RAM. [2,9] SA has one of the greatest dual burdens of tuberculosis (TB) and HIV infection globally, and both infections have well-established relationships with VTE development.…”

“…[1,2] VTE is linked to increased healthcare costs, intensive care unit admission and longer hospital stay. [3] Findings from the multinational ENDORSE (Epidemiologic International Day for the Evaluation of Patients at Risk for Venous Thromboembolism in the Acute Hospital Care Setting) study revealed that more than half of all hospitalised patients were at risk for VTE, and 41.5% of these were medical inpatients. [4] A multinational, crosssectional survey conducted across five countries in sub-Saharan Africa found that a greater proportion of medical inpatients were at risk for VTE (62.3%) compared with surgical patients (43.8%).…”

“…[6,7] This lack of data extends across both the private and public healthcare sectors. [2,3] The SA-based TUNE-IN (The Use of VTE prophylaxis in relatioN to patiEnt risk profiling) study aimed to assess VTE prophylaxis use in hospitalised patients in relation to their risk profile. The authors reported a 67.1% risk of VTE in medical inpatients admitted to private healthcare sector hospitals across Gauteng Province, SA.…”

“…[8] VTE can be prevented through the provision of appropriate non-pharmacological and/or pharmacological prophylaxis following individualised patient screening with a structured risk assessment model (RAM) or through clinical evaluation. [3,9] The Caprini RAM offers a simple and comprehensive approach to VTE risk assessment in both surgical and medical inpatients. [1][2][3] Furthermore, it has undergone several modifications since its introduction in 1991 and has been validated in >250 000 patients in >100 trials worldwide.…”

“…[3,9] The Caprini RAM offers a simple and comprehensive approach to VTE risk assessment in both surgical and medical inpatients. [1][2][3] Furthermore, it has undergone several modifications since its introduction in 1991 and has been validated in >250 000 patients in >100 trials worldwide. [1] Development of the Caprini RAM was based on the implementation of the American College of Chest Physicians (ACCP) thromboprophylaxis guideline, one of the leading VTE prophylaxis This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.…”