Patients Admitted with Acute Abdominal Conditions are at High Risk for Venous Thromboembolism but Often Fail to Receive Adequate Prophylaxis (original) (raw)
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Venous Thromboembolism Risk and Thromboprophylaxis Among Hospitalized Patients
Clinical and Applied Thrombosis/Hemostasis, 2010
Objectives: To evaluate venous thromboembolism (VTE) risk and use of thromboprophylaxis in the acute care hospital setting. Methods: A total of 1701 patients hospitalized for acute or exacerbated chronic medical illnesses or elective major surgery at 11 different hospitals across Turkey were included in the study. Patients at risk and VTE prophylaxis application were retrospectively identified based on medical charts. Results: According to the American College of Chest Physicians (ACCP) criteria, overall 35.6% (606 of 1701) of the patients were identified to be at VTE risk. Venous thromboembolism-risk was observed in 64.9% of surgical and 23.8% of medical patients, the latter being lower than global Epidemiologic International Day for the Evaluation of Patients at Risk for Venous Thromboembolism in the Acute Hospital Care Setting (ENDORSE) study results; while prophylaxis was prescribed in 39.0% and 38.5% of them, respectively. Contraindication to anticoagulant prophylaxis was obser...
SciMedicine Journal
Background: Venous thromboembolism (VTE) is a common and preventable disease among non-surgical hospitalized patients. Its incidence is high and alarming. Acute medical patients have VTE risk during and after hospitalization. The Padua prediction score is a risk model created to identify high VTE risk patients among non-surgical hospitalized patients. Methods: We performed a cross-sectional survey of 107 patients admitted to Internal Medicine wards who were assessed as acutely ill patients at Emergency Department, in a period of 4 weeks. The demographic and clinical data were collected using a designed questionnaire. VTE risk was defined as having a Padua Prediction score of ≥4 points. A statistical analysis was done to determine prevalence. The patients at high VTE risk received thromboprophylaxis. Results: One hundred and seven eligible patients were included. 84% were found to be at high risk for VTE. Among physiologically unstable patients, 60% of the patients were classified in...
Venous thromboprophylaxis in medical patients: an application review
Revista da Associação Médica Brasileira (English Edition), 2013
Routine thromboprophylaxis, despite its well-known effectiveness and the fact that venous thromboembolism is a potentially avoidable condition, is not fully established in clinical practice. The objectives of the present study were to determine how often thromboprophylaxis is used and the presence of thromboembolism risk factors, and to verify the appropriateness of its use in medical inpatients, assuming a long-standing national guideline as a parameter. Methods: This was a retrospective cross-sectional study, involving inpatients with medical conditions in the adult general ward of a faculty hospital. The review was based on a defined guideline. Results: 146 patients were included in the review. At least one risk factor for venous thrombo embolism was found in 94.5%. In 130 (89%) patients, prophylactic heparin was indicated, and some kind of heparin was prescribed in 73.3%. Regarding the adequacy of prophylaxis, 53.4% of prescriptions were correct regarding prophylaxis indication and dose; 24% had incorrect dose or frequency of use; 19.2% had no prophylaxis prescription, although it was indicated; and in five cases (3.4%), the drug was prescribed, even though it was not indicated. Conclusion: Thromboprophylaxis is underused in this population, and an inappropriate dose was prescribed in 50% of cases. Therefore, future studies and interventions should include an educational program started from the emergency department care, an essential step to bring evidence closer to clinical practice.
Assessment of venous thromboembolism risk and the benefits of thromboprophylaxis in medical patients
Thrombosis and Haemostasis, 2005
Hospitalizedp atientsw ith acute medicalc onditionsa re at significantriskofvenous thromboembolism (VTE): approximately 10-30% of general medical patients mayd evelop deep-vein thrombosis or pulmonaryembolism, andthe latter is aleading contributortodeaths in hospital. Despite consensus-group recommendations that at-riskm edical patients should receive thromboprophylaxis, there is currentlyn oc onsensusa st o which patients areatrisk,and manypatientsmay not receiveappropriate thromboprophylaxis.This paperreviews evidence for the risk of VTE associated with differentmedical conditions and riskfactors, and presents arisk-assessment modelfor risk stratification in medical patients. Medicalconditionsassociated with
European Journal of Internal Medicine, 2012
Venous thromboembolism (VTE) is frequent in patients hospitalized in Internal Medicine wards. It carries a considerable morbidity and mortality. Recommendations for use of anticoagulation are graded 1A in leading evidence-based consensus guidelines. Implementation of these guidelines is suboptimal. Lack of awareness seems to be an important factor for the low implementation rate of thromboprophylaxis in Internal Medicine wards, but other factors may be equally important: some clinicians find the data favoring thromboprophylaxis unconvincing or believe that pharmacological prevention is too risky for the average medical inpatient. The following review will show that although there is a dispute about the clinical importance of some manifestations of thromboembolic disease, anticoagulation significantly reduces the risk for clinically relevant VTE. The bleeding risk in most patients is low and does not outweigh the benefit of treatment. Pharmacological or mechanical thromboprophylaxis is cost-effective when administered to at-risk patients. Better awareness and judicious use of risk assessment models should help the attending physician to balance the risk of VTE against the potential bleeding risk.
Vascular Health and Risk Management
We aimed to determine the incidence of venous thromboembolism among hospitalized patients in Qatar as well as to analyze the adequacy of VTE assessment and prophylaxis in hospitalized patients. Design: Retrospective observational study. Setting: Four hospitals under Hamad Medical Corporation, Qatar. Participants: Patients over the age of 18 who were hospitalized between January 2015 and December 2019 and developed venous thromboembolism during hospitalization or within a month after discharge were included. Results: During the study period, 641,994 individuals were admitted to hospitals. The inclusion criteria were satisfied by 209 of them. The mean age was 51.25 years and 54.5% were males. Hypertension and diabetes mellitus were the most common comorbidities found in the overall group. The incidence of VTE was 32.55 [95% CI 28.4, 37.3] per 100,000 admission per year [0.032%]. The annual incidence was least in 2015 (17.8 per 100,000 admissions) and highest in 2018 (44.4 per 100,000 admissions). Eighty-six subjects had DVT, and 109 had PE, whereas 14 had both. And, 67.5% of the patients developed VTE during admission while, 32.5% developed within 1 month of discharge. Moreover, 22.9% of the patients with PE developed pulmonary embolism after discharge from the hospital. VTE assessment was performed on 64.7% of the patients, and 69.7% received VTE prophylaxis in accordance with guidelines. Conclusion: Although the occurrence of VTE among hospitalized patients in Qatar is low, healthcare providers need additional education and knowledge of VTE assessment and prophylaxis to follow guidelines for all patients at the time of admission. Furthermore, risk assessment for VTE should be done for all patients at the time of discharge to decide on post-discharge prophylaxis so that incidence of VTE after discharge can be minimized. Future studies should focus on patients who developed VTE after discharge from the hospital as well as on various risk factors.