A cross-sectional, multicenter, observational study to assess the prophylaxis of venous thromboembolism in Lebanese and Jordanian hospitals

Imad Hajj,Kaldoun Bashaireh,Shadi Hamouri,Nisrine Sabra,Chahine Fadel,Mahmoud Al-Masri,Joe Khouzami,Mohammed Bani Hani

doi:10.1186/s12959-021-00261-2

Abstract

BackgroundThere is a growing body of evidence showing substantial underuse of appropriate venous thromboembolism (VTE) prophylaxis in patients at risk. In the present study, our goal was to assess the current practices in the use rate of VTE prophylaxis among hospitalized patients in Jordan and Lebanon.MethodsA cross-sectional, multicenter, observational study was conducted on 40 centers across Lebanon and Jordan. We included patients who were admitted to the participating hospitals for the treatment of a serious medical or surgical illness. The patients’ records were screened for the fulfillment of inclusion/exclusion criteria during a single assessment visit. The proportion of medical and surgical patients who were at risk of VTE and the thrombo-prophylactic measures employed by physicians for these patients were assessed according to the American College of Chest Physicians (ACCP 2016) guidelines.ResultsThe present study included 704 patients (400 from Jordan and 304 from Lebanon) with a mean age of 54.9 ± 17.5 years. Almost 59% of the patients received prophylaxis treatment in form of pharmacological anticoagulant prophylaxis and/or mechanical prophylaxis. Low molecular weight heparin was the most commonly used anticoagulant for VTE prophylaxis in 366 out of the total 704 (51.9%) patients in the analysis cohort. Two hundred and sixteen patients (52, 95% confidence interval [47.1–56.9%]) received appropriate prophylactic agents out of 415 patients who were eligible for prophylaxis according to the ACCP 2016 guidelines. On the other hand, 199 (72.1, 95% confidence interval [66.4–77.3%) patients received prophylaxis out of 276 ineligible patients. The rate of compliance to guidelines showed wide variations according to the type of hospital, specialty, and the patients’ age. The multivariate logistic regression analysis showed that only age was a significant predictor of appropriate VTE prophylaxis (odds ratio [OR] 1.05, P < 0.001).ConclusionThe rates of the appropriate use of VTE prophylaxis are low in Lebanon and Jordan. There is a lack of compliance to guidelines for VTE prophylaxis use for hospitalized patients in both countries.

Highlights

Venous thromboembolism (VTE) is a life-threatening disorder and a major cause of morbidities and mortality among hospitalized patients [1]
The multivariate logistic regression analysis showed that only age was a significant predictor of appropriate venous thromboembolism (VTE) prophylaxis in the present study (Table 6)
Not received prophylaxis aAccording to American College of Chest Physicians (ACCP) guidelines multinational, study, we found that the rates of the appropriate use of VTE prophylaxis were 60.93 and 45.08% of the medical and surgical hospitalized patients, who were eligible for VTE prophylaxis, respectively

Summary

Introduction

Venous thromboembolism (VTE) is a life-threatening disorder and a major cause of morbidities and mortality among hospitalized patients [1]. Previous reports demonstrated that up to 20% of hospitalized medical patients are expected to develop VTE during hospital stay [7]. VTE is a major cause of mortality in hospitalized patients as well; up to 10% of fatality cases during hospitalization were attributed to VTE in autopsy-based studies [8]. Effective VTE prophylaxis among hospitalized at-risk patients, either surgical or medical, is critical in improving patients’ outcomes and survival [9]. There is a growing body of evidence showing substantial underuse of appropriate venous thromboembolism (VTE) prophylaxis in patients at risk.

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Conclusion