Venous thromboembolism risk factors and practices of prophylaxis: ENDORSE study results in Portugal.

Abstract

Venous thromboembolism (VTE) risk assessment is a cornerstone for the achievement of best practices and outcomes. Epidemiologic data and practices related to venous thromboprophylaxis as considered by the global ENDORSE study, (Epidemiologic International Day for the Evaluation of Patients at Risk for Venous Thromboembolism in the Acute Hospital Care Setting), enrolled 68,183 patients from 32 countries, in which Portugal. Within ENDORSE, data from all participant countries analyzed to determine their risk of VTE and to evaluate the suitability of prophylaxis.European patients were enrolled from randomly selected hospitals in Portugal (European Hospital Register), according to ENDORSE study inclusion/exclusion criteria. The Seventh ACCP evidence-based consensus guidelines were employed to evaluate VTE risk and prophylaxis use.From a total of 3,145 beds assessed, 2,183 were considered eligible and 1,632 met all criteria. Of these, 860 (52.7%; 95% CI 50.3-55.1) were at risk of VTE: 525 surgical patients (68.9%; 95% CI 65.5-72.1) and 335 medical patients (38.5%; 95% CI 35.3-41.2). The rate of prophylaxis according to ACCP guidelines in overall patients at risk was 58.5% (503 patients). The prophylaxis rate for VTE was 59% (310 patients) in surgical patients and 57.6% (n=193) in medical patients. 39.7% of surgical patients and 39.4 % of medical patients who did not meet the criteria for prophylaxis were also on prophylaxis with an anticoagulant, which was considered to be inappropriate.More than a half of these hospitalized patients in Portugal were deemed at risk of VTE and less than two-thirds of them received appropriate prophylaxis. New strategies are required for implementation of venous thromboprophylaxis in Portuguese hospitals.

Venous Thromboembolism Prophylaxis in Medical and Surgical Patients – What’s Our Reality?

“…In 68.9%, inappropriate pharmacological prophylaxis was administered, leading to an increased risk of bleeding events and costs. This finding is consistent with other studies that have shown high use of prophylaxis in low-risk patients [ 7 , 13 ]. These results could reflect either a clinical judgment of real risks and, if so, a clinically correct decision or an incorrect risk assessment [ 7 , 13 ].…”

“…Regarding surgical patients, the results were somewhat unsatisfactory. When compared to the ENDORSE study, we pinpoint a lower rate of patients under adequate prophylaxis (42.0% in our study versus 58.5% in the ENDORSE study), however, our results are far better than those from some international studies, like DissolVE-2, which reports a 10.3% rate of risk-patients receiving adequate prophylaxis [ 8 , 13 ]. In addition, the rate of patients undergoing inadequate prophylaxis was 58.0%, well above expectations, compared to other studies reporting rates inferior to 40.0% [ 13 ].…”

“…When compared to the ENDORSE study, we pinpoint a lower rate of patients under adequate prophylaxis (42.0% in our study versus 58.5% in the ENDORSE study), however, our results are far better than those from some international studies, like DissolVE-2, which reports a 10.3% rate of risk-patients receiving adequate prophylaxis [ 8 , 13 ]. In addition, the rate of patients undergoing inadequate prophylaxis was 58.0%, well above expectations, compared to other studies reporting rates inferior to 40.0% [ 13 ]. It is important to point out the low adherence to mechanical thromboprophylaxis, indicated in patients with a low VTE risk, but only applied in elevated bleeding risk individuals.…”

“…On the one hand, a relatively high percentage of high-risk patients received thromboprophylaxis (86.6%), both mechanical and/or pharmacological strategies. This is substantially better than described in previous studies, including Portuguese publications [ 7 , 8 , 13 , 23 ], probably emphasizing an increasing awareness of this topic. On the other hand, the overall rate of inappropriate prophylaxis in low-risk medical patients was 73.3%.…”

“…In Portugal, the ENDORSE study revealed that 52.7% of all hospitalized patients were at risk of VTE. However, the rate of adequate thromboprophylaxis was only 58.5%, and more than a third of patients, although unsuitable, were offered thromboprophylaxis inappropriately [ 7 , 13 ]. A more recent study also revealed that even though a substantial proportion of medical and surgical patients were at risk for VTE, implementation of prophylaxis was low, particularly in medical patients [ 8 ].…”