Abstract
BackgroundProphylactic venous thromboembolism (VTE) strategies have the greatest impact on patient outcomes. Both global and local guidelines support VTE prophylaxis for hospitalised patients. However, studies have reported that these measures are routinely under-prescribed. This study evaluated prescribing patterns of VTE prophylaxis in one of the largest South African (SA) private hospital groups.MethodsA quantitative, retrospective analysis of the hospital group’s patient database was conducted for patients admitted between 01 September 2015 and 31 August 2016. Those younger than 18 years with trauma or suffering from contraindications to anticoagulation were excluded. Additionally, patients with warfarin billed were also excluded as they possibly required therapeutic anticoagulation. Included prophylactic measures were compared with published SA guidelines by abstracting prophylaxis type and dosing, according to corresponding individual patients’ VTE risk ratings.ResultsAmongst the 373 020 patients included as the study population, 77% required prophylaxis. Of these, 38.36% (n = 85 486) received guideline-appropriate prophylactic measures during their hospital stay. Patients in whom prophylaxis was indicated, only 24.56% (n = 42 715) complied with the SA guidelines. The most commonly used prophylactic measures were enoxaparin (89.09%) and fondaparinux (2.68%). Prophylactic measures differed per speciality, with the most compliant amongst intensivists. A low uptake of the risk assessment model use (n = 222 860, 59.75%) was, however, reported for this data set.ConclusionLess than 24.56% of patients who required prophylaxis received guideline-appropriate interventions. Further studies should focus on understanding differences in practice and improving acceptance and application of guideline-driven care.
Highlights
The global incidence of venous thromboembolism (VTE) has been reported to be exceptionally high with an annual overall prevalence rate similar to that of stroke, the fifth leading cause of death worldwide.[1]
This study confirms that most prescriber specialities do not prescribe VTE prophylaxis according to published local, consensus-derived guidelines
It can further be concluded that patients are more likely to receive some form of VTE prophylaxis if they are at high risk of VTE development
Summary
The global incidence of venous thromboembolism (VTE) has been reported to be exceptionally high with an annual overall prevalence rate similar to that of stroke, the fifth leading cause of death worldwide.[1]. Venous thromboembolic disease is debilitating and presents a high economic burden on a country’s healthcare system This is mainly because of a 45% increased cost for recurrent hospitalisation with VTE-related comorbid diseases.[7] Recurring VTE-related hospitalisations often require a 48% increased expenditure when compared with the initial admission period.[8] It is estimated that the highest cost is suffered during the first 3 days after re-hospitalisation, possibly because of the higher level of care required.[9] Up to 24% of patients diagnosed with VTE will eventually require intensive care unit re-admission.[9] In 2014, VTE-related hospitalisation cost the United States healthcare system around $10 billion, and in 2017, it was established through personal communication that one of South Africa’s largest private hospital groups spent over https://www.safpj.co.za. This study evaluated prescribing patterns of VTE prophylaxis in one of the largest South African (SA) private hospital groups
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Schedule a callMore From: South African family practice : official journal of the South African Academy of Family Practice/Primary Care
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