Abstract
Background Venous thromboembolism (VTE) is a silent and potentially lethal disease that affects a considerable proportion of hospitalized patients. It has high morbidity and mortality and is responsible for a heavy financial burden on healthcare systems. However, VTE can be prevented using prophylaxis measures that have been established in the literature. Nonetheless, in the real world, mean rates of appropriately administered VTE prophylaxis are lower than 50%. Objectives To define the epidemiological profile of patients with VTE in a University Hospital and the rate of appropriately administered VTE prophylaxis at that service and to identify measures to improve the rate. Methods A cross-sectional, observational study was conducted with data collected from the medical records of patients who met the inclusion criteria. The rates of correct VTE prophylaxis prescribed to clinical and surgical patients were compared, assessed according to guidelines published by the Brazilian Society of Angiology and Vascular Surgery (SBACV), based on VTE risk classification. Results The overall rate of correctly-prescribed VTE prophylaxis was 42.1%, while 57.9% of patients were not managed correctly in this respect. Clinical patients had a 52.9% rate of appropriate prophylaxis, while the equivalent rate for surgical patients was 37.5%. Conclusions Rates of correctly-prescribed VTE prophylaxis are still lower than they should be. Ongoing education, measures to encourage bedside risk stratification, and improvements to the electronic prescription system could increase appropriate VTE prophylaxis rates.
Highlights
The sample was divided into two categories: A) clinical patients (n = 136, 29.8%) and B) surgical patients (n = 320, 70.2%), on the basis of the protocols for risk and prophylaxis indications produced by the Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)
The patients analyzed were hospitalized for a variety of reasons and for periods judged necessary by the healthcare team, which was responsible for choosing Venous thromboembolism (VTE) prophylaxis prescriptions
The data collected reiterate the epidemiological profile described in the literature on patients at increased risk of VTE, since we found that patients had multiple
Summary
Pharmaceutical and mechanical prophylactic measures to prevent venous thromboembolism (VTE) are well-established in international consensuses, for both clinical and surgical patients,[1,2] based on risk stratification models.[3,4,5] many Brazilian[5,6] and international publications show that, in the real world, approximately 50% of patients at risk of VTE are not being prescribed chemical prophylaxis when it is indicated, or are being given inappropriate prophylaxis.[7,8] Rates of correctly-prescribed prophylaxis vary across different countries and different services from 2 to 92%.9-11 According to the ENDORSE study, Brazil has inappropriate prophylaxis rates of 41% for clinical patients and 54% for surgical patients.[11]. Pharmaceutical and mechanical prophylactic measures to prevent venous thromboembolism (VTE) are well-established in international consensuses, for both clinical and surgical patients,[1,2] based on risk stratification models.[3,4,5] many Brazilian[5,6] and international publications show that, in the real world, approximately 50% of patients at risk of VTE are not being prescribed chemical prophylaxis when it is indicated, or are being given inappropriate prophylaxis.[7,8] Rates of correctly-prescribed prophylaxis vary across different countries and different services from 2 to 92%.9-11. Venous thromboembolism (VTE) is a silent and potentially lethal disease that affects a considerable proportion of hospitalized patients. It has high morbidity and mortality and is responsible for a heavy financial burden on healthcare systems. Measures to encourage bedside risk stratification, and improvements to the electronic prescription system could increase appropriate VTE prophylaxis rates
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