Venous thromboembolism prophylaxis in patients hospitalized in medical wards

Abstract

Venous thromboembolism (VTE) is a preventable cause of morbidity and mortality in acutely ill patients hospitalized in medical departments. Thromboprophylaxis with anticoagulants was shown to be safe and effective in medical patients with high risk to develop VTE. Despite guidelines recommendations, the rate of thromboprophylaxis in those patients is low. The objective of the study was to evaluate the rate of VTE risk assessment in routine medical department practice, the rate of eligible patients for thromboprophylaxis, the rate of patients who received thromboprophylaxis, and their outcome. Medical records of consecutive patients (3000 at 2013, 1000 at 2018) hospitalized in medical department were reviewed, retrospectively, for demographic, clinical characteristics, thromboprophylaxis treatment with enoxaparin and outcome (up to 90 days following discharge). Padua score was used for VTE risk assessment. VTE diagnosis was based on clinical suspicion. The mean patient's age (52.6% females) was 67.95 ± 21.56 years. 21% were eligible for thromboprophylaxis. Routine VTE risk assessment rate increased significantly following its incorporation into quality parameters, but the rate of treated patients was low (22% at 2013; 46% at 2018). The patients who received thromophylaxis were sicker compared to eligible patients without thromboprophylaxis. The rate of symptomatic VTE was low (0.24%; 0.12% and 0.55% for low and high VTE risk, respectively). Thromboprophylaxis did not have significant effect on the low number of VTE events. No major bleeding was observed. Major efforts are still needed to increase the rate of thromboprophylaxis in all eligible medical patients according to the guidelines recommendations.

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

“…In the present study, the incidence of VTE events was 6.84% which is higher than that of the Israel’s study (0.24%), 28 but almost similar to the other study conducted in Ethiopia (5.5%). 23 The high incidence of VTE in our study compared to the study reported in Israel could be linked to failure to assess risk factors and lower rate of utilization of thromboprophylaxis for eligible patients.…”

VTE Prophylaxis Therapy: Clinical Practice vs Clinical Guidelines

“… 19 , 20 Furthermore, the VTE assessment rate was increased when incorporating assessment models into quality parameters, where 98.6% of hospital admitted patients were screened for initiating VTE prophylaxis. 21 …”

Prophylaxis of Venous Thromboembolism in Patients with Infectious Disease

“…About 30.1% had a Padua score of 4 points or more (representing high risk of VTE), which is indication for VTE prophylaxis. In this study, 25.1% of patients had infectious disease, but there was no analysis to assess the outcome in the subgroup of patients with infectious disease 15 .…”

“…In real-life observational study, Mahlab-Guri et al 15 reported that thromboprophylaxis did not have significant effect on reducing the number of VTE events, even though the rate of patients treated for thromboprophylaxis increased from 22% at 2013 to 46% at 2018. The risk of VTE was calculated with Padua score which includes malignancy, previous VTE, obesity, elderly age, bedrest, acute infection and so on 15 . About 30.1% had a Padua score of 4 points or more (representing high risk of VTE), which is indication for VTE prophylaxis.…”

“…We need to increase the rate of prophylaxis in genuine candidates with high risk of VTE (Padua score of 4 points or more). There are still controversies about the most appropriate candidates and duration for prophylaxis of VTE in medically ill patients in recent studies 11,12,15 . We have to make our own efforts to identify candidates for VTE prophylaxis in retrospective and prospective studies in South Korea.…”