Risk stratification for venous thromboembolism in hospitalized patients in a developing country: a prospective study

Awidi, Abdallah; Obeidat, Nathir M.; Magablah, Ahmad; Bsoul, Nazzal

doi:10.1007/s11239-008-0291-1

Cited by 21 publications

(23 citation statements)

References 20 publications

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“…Similar results were found in different parts of the world, the Middle Eastern countries in particular, where the majority of patients were found to be at high risk of VTE and yet VTE prophylaxis was underused [26,29]. Medical patients were given drug prophylaxis less than surgical patients (P \ 0.001), although they had higher percentages of VTE risk factors.…”

Section: Discussionsupporting

confidence: 79%

“…There are however some discrepancies: a few of the very well known driver variables for VTE prophylaxis in existing international literature [39] were rather found as inversely correlated to it in our study (both in bivariate and multivariate analyses), such as cancer therapy in combined patient population, acute renal problem and malignancy in medical patients; this was shown in the Middle Eastern countries [26][27][28][29] and other locations [40][41][42]. Fear of bleeding is one of the most cited reasons for underprophylaxis [43,44].…”

Section: Discussioncontrasting

confidence: 54%

“…The ENDORSE study included countries from all around the world, but only two (467 patients from the Kingdom of Saudi Arabia and the United Arab Emirates) of the Middle Eastern regions were involved in this study. Miscellaneous studies also exist for VTE prophylaxis in different Middle Eastern countries, but they are performed on heterogeneous populations in different times and they use different methodologies [24][25][26][27][28][29], thus not allowing appropriate interpretation.…”

Section: Introductionmentioning

confidence: 99%

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The AVAIL ME study: a multinational survey of VTE risk and prophylaxis

Taher

Aoun

Salameh

2010

J Thromb Thrombolysis

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Venous thromboembolism (VTE) is a major public health issue that is frequently underestimated. The primary objective of this multinational survey was to identify patients at risk for VTE, and to define the rate of patients receiving appropriate prophylaxis in the Middle Eastern region. Standardized case report forms were filled by trained individuals on one predefined day in selected hospitals. Data were then entered and analyzed by independent biostatisticians. Risk was categorized according to American College of Chest Physicians (ACCP) guidelines, 2004. Logistic regressions were carried out to assess factors that determined VTE prophylaxis. 845 (37%) medical and 1421 (63%) surgical patients were eligible for the study. Patients were at low (4.2%), moderate (51.7%), high (9%) and very high risk (35.2%) for VTE. Any VTE prevention was given in 17.9, 41.7, 60.6 and 66.9% of respective risk categories, while ACCP guidelines were applied in 86.3, 41.1, 48.3 and 24.5% of these categories. Surgical patient type, immobility on admission, and contraceptive use were the most important drivers of VTE prophylaxis in those who were eligible to it (OR ≥ 2). Surgical patient type, immobility during hospitalization, existence of a VTE protocol and chronic heart failure were the most important drivers for VTE prophylaxis application in patients who were not eligible for it (OR ≥ 3). A concordance κ value of 0.16 was found between eligibility for VTE prophylaxis on one hand and its application in practice (P < 0.001). Risk factors for VTE and eligibility for VTE prophylaxis are common, but VTE prophylaxis and guidelines application are low.

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Section: Discussionsupporting

confidence: 79%

Section: Discussioncontrasting

confidence: 54%

Section: Introductionmentioning

confidence: 99%

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The AVAIL ME study: a multinational survey of VTE risk and prophylaxis

Taher

Aoun

Salameh

2010

J Thromb Thrombolysis

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“…Practitioners in these countries recognize the economic and other difficulties of providing anticoagulants for all patients for whom they are not contraindicated and recommend careful risk stratification and education [80,82]. Education could include dietary advice.…”

Section: Randomized Controlled Non-inferiority Trials Of Anticoagulanmentioning

confidence: 99%

Diet as prophylaxis and treatment for venous thromboembolism?

Cundiff

Agutter²,

Malone³

et al. 2010

Theor Biol Med Model

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BackgroundBoth prophylaxis and treatment of venous thromboembolism (VTE: deep venous thrombosis (DVT) and pulmonary emboli (PE)) with anticoagulants are associated with significant risks of major and fatal hemorrhage. Anticoagulation treatment of VTE has been the standard of care in the USA since before 1962 when the U.S. Food and Drug Administration began requiring randomized controlled clinical trials (RCTs) showing efficacy, so efficacy trials were never required for FDA approval. In clinical trials of 'high VTE risk' surgical patients before the 1980s, anticoagulant prophylaxis was clearly beneficial (fatal pulmonary emboli (FPE) without anticoagulants = 0.99%, FPE with anticoagulants = 0.31%). However, observational studies and RCTs of 'high VTE risk' surgical patients from the 1980s until 2010 show that FPE deaths without anticoagulants are about one-fourth the rate that occurs during prophylaxis with anticoagulants (FPE without anticoagulants = 0.023%, FPE while receiving anticoagulant prophylaxis = 0.10%). Additionally, an FPE rate of about 0.012% (35/28,400) in patients receiving prophylactic anticoagulants can be attributed to 'rebound hypercoagulation' in the two months after stopping anticoagulants. Alternatives to anticoagulant prophylaxis should be explored.Methods and FindingsThe literature concerning dietary influences on VTE incidence was reviewed. Hypotheses concerning the etiology of VTE were critiqued in relationship to the rationale for dietary versus anticoagulant approaches to prophylaxis and treatment.Epidemiological evidence suggests that a diet with ample fruits and vegetables and little meat may substantially reduce the risk of VTE; vegetarian, vegan, or Mediterranean diets favorably affect serum markers of hemostasis and inflammation. The valve cusp hypoxia hypothesis of DVT/VTE etiology is consistent with the development of VTE being affected directly or indirectly by diet. However, it is less consistent with the rationale of using anticoagulants as VTE prophylaxis. For both prophylaxis and treatment of VTE, we propose RCTs comparing standard anticoagulation with low VTE risk diets, and we discuss the statistical considerations for an example of such a trial.ConclusionsBecause of (a) the risks of biochemical anticoagulation as anti-VTE prophylaxis or treatment, (b) the lack of placebo-controlled efficacy data supporting anticoagulant treatment of VTE, (c) dramatically reduced hospital-acquired FPE incidence in surgical patients without anticoagulant prophylaxis from 1980 - 2010 relative to the 1960s and 1970s, and (d) evidence that VTE incidence and outcomes may be influenced by diet, randomized controlled non-inferiority clinical trials are proposed to compare standard anticoagulant treatment with potentially low VTE risk diets. We call upon the U. S. National Institutes of Health and the U.K. National Institute for Health and Clinical Excellence to design and fund those trials.

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“…Despite development of various Practice guidelines for prevention of Venous Thromboembolism (VTE), it remains underused in most countries [5,6]. Improving clinician's compliance with the guidelines is a complex task and partly rest on improving thrombotic risk-assessment methods [7].…”

Section: Introductionmentioning

confidence: 99%

Practice guidelines and clinical risk assessment models: is it time to reform?

Sepehrvand

Pakdel

Rahimi-Rad

et al. 2011

BMC Med Inform Decis Mak

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BackgroundClinical practice guidelines and Risk Assessment Models (RAMs) are some useful tools to bring medical evidences into our daily clinical practice. Despite the improvement over the time, they still have some shortcomings.DiscussionOne of these shortcomings is the arbitrary cutoffs used in these tools to facilitate the decision making process. This problem is to some extent due to the "Black or White" approach of modern medicine in making the decisions, whilst in the real world and our daily practice we used mostly an uncertain approach, which is called recently as "Fuzzy" thinking approach.SummaryThe authors of this article believe that the fuzzy type of thinking may resolve the above mentioned shortcomings of clinical practice guideline or risk assessment models and they tried to discuss about this using an example about Venous Thromboembolism related guidelines and RAMs.

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Risk stratification for venous thromboembolism in hospitalized patients in a developing country: a prospective study

Cited by 21 publications

References 20 publications

The AVAIL ME study: a multinational survey of VTE risk and prophylaxis

The AVAIL ME study: a multinational survey of VTE risk and prophylaxis

Diet as prophylaxis and treatment for venous thromboembolism?

Practice guidelines and clinical risk assessment models: is it time to reform?

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