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

Abstract

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.

Incidence of hospital-acquired venous thromboembolic disease.

“…Another interesting factor to recognize in this context: thromboprophylaxis status during hospitalizations given the clinical implications it could have on the IR; but we do not have that information on this particular population. However, we know from a previous study in Argentina that the adequacy of antithrombotic prophylaxis was provided to 66.9% of the patients, and was more frequent in surgical (71%) compared to clinical (63.6%) subjects (p < 0.001) [11] . Moreover, VTE remains a common complication of cancer surgery, with a remarkable proportion of events occurring late after surgery [17] ; while this study evaluate intrahospital event.…”

“…A retrospective cohort of all inpatients admitted in a tertiary university hospital between July 2006 and August 2013, in Buenos Aires, Argentina. The inclusion criteria were defined as follows: adult patient >17 years, consecutively admitted to the Hospital Italiano de Buenos Aires (HIBA) between July 2006 to August 2013, for any clinical or surgical causes [10][11][12] . Patients admitted for VTE were excluded; all patients at the time of admission to the hospital were free of event.…”

Estratificação De Risco Para Tromboembolismo Venoso Em Pacientes De Um Hospital Público Do Distrito Federal

“…Em estudo americano (20) , a frequência de óbito no grupo de alto risco foi maior que no grupo baixo risco, dados estes concordantes com o presente estudo no qual a taxa de óbito no grupo alto risco foi duas vezes maior. A ACCP indica aos pacientes clínicos, estratificados com alto risco, a tromboprofilaxia anticoagulante farmacológica, e como medidas não farmacológicas preconizam-se: meias de compressão graduadas, intermitentes e dispositivos pneumáticos de compressão (3) .…”

Frequência de profilaxia para tromboembolismo venoso

“…Em um estudo com 296 pacientes cirúrgicos para avaliar a incidência de TVP e a qualidade da profilaxia para TEV, Okuhara et al 22 afirma que a profilaxia para TVP foi correta em 57,7% dos pacientes, um número aquém do encontrado em nosso trabalho. Entretanto, em um estudo envolvendo 1.315 indivíduos (729 pacientes clínicos e 586 pacientes cirúrgicos), Vazquez et al 23 afirma que a profilaxia antitrombótica foi realizada adequadamente em 66,9% dos indivíduos, sendo mais frequente em pacientes cirúrgicos (71%) do que nos pacientes clínicos (63,6%), resultado consonante com o apresentado pelo presente estudo. Entretanto, em relação aos pacientes com inadequação da profilaxia, Vazquez et al 23 relatou que a profilaxia foi insuficiente em 76,6% dos pacientes.…”

“…Entretanto, em um estudo envolvendo 1.315 indivíduos (729 pacientes clínicos e 586 pacientes cirúrgicos), Vazquez et al 23 afirma que a profilaxia antitrombótica foi realizada adequadamente em 66,9% dos indivíduos, sendo mais frequente em pacientes cirúrgicos (71%) do que nos pacientes clínicos (63,6%), resultado consonante com o apresentado pelo presente estudo. Entretanto, em relação aos pacientes com inadequação da profilaxia, Vazquez et al 23 relatou que a profilaxia foi insuficiente em 76,6% dos pacientes. Na presente pesquisa, o principal motivo de profilaxia inadequada consistiu em medidas excessivas, sejam doses mais altas do que as recomendadas ou doses corretas, porém para pacientes sem indicação de receber quimioprofilaxia.…”