Venous thromboembolism prophylaxis in patients undergoing abdominal and pelvic cancer surgery: adherence and compliance to ACCP guidelines in DIONYS registry.

Negib Geahchan,Maroon Tohmeh,Melkart Basile

doi:10.1186/s40064-016-3057-9

Negib Geahchan, Maroon Tohmeh + Show 1 more

Open Access

https://doi.org/10.1186/s40064-016-3057-9

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Journal: SpringerPlus	Publication Date: Sep 13, 2016
Citations: 17	License type: CC BY 4.0

Affiliation: Saint Joseph University, Lebanese University

Abstract

BackgroundVenous thromboembolism (VTE) is a major health care problem resulting in significant mortality, morbidity and increase in medical expenses. Patients with malignant diseases represent a high risk population for VTE. The American College of Chest Physicians (ACCP) proposed, since 1986, prophylaxis guidelines that are unequally respected in surgical practice.MethodsDIONYS is a multinational, longitudinal and non-interventional registry including patients having undergone abdominal or pelvic surgery for cancer in Latin America, Africa and the Middle East. Patients were evaluated with regard to VTE prophylaxis, during three consecutive visits, for their adherence to ACCP 2008 guidelines. Data were collected on type and duration of VTE prophylaxis, adherence to guidelines, and compliance with prescriptions, complications and possible reasons for omission of prophylaxis.ResultsBetween 2011 and June 2012, 921 adult patients were included and divided into abdominal (435), pelvic (390) and combined abdominal and pelvic surgery (96), 65.4 % being females. VTE prophylaxis was prescribed to 90 % of patients during hospitalization and to 28.3 % after hospital discharge. Prescriptions adhered to ACCP guidelines in 73.9 % of patients during hospitalization and 18.9 % after discharge. The reason of non-adherence was mainly the clinical judgment by the physician that the patient did not need a prophylaxis. The most commonly prescribed type of prophylaxis was pharmacological (low molecular weight heparin).ConclusionA wide gap exists between VTE prophylaxis in daily practice and the ACCP 2008 guidelines, in abdominal and pelvic cancer surgery. A better awareness of surgeons is probably the best guarantee for improvement of VTE prophylaxis in surgical wards.Electronic supplementary materialThe online version of this article (doi:10.1186/s40064-016-3057-9) contains supplementary material, which is available to authorized users.

Highlights

Venous thromboembolism (VTE) is a major health care problem resulting in significant mortality, morbidity and increase in medical expenses
Geahchan et al SpringerPlus (2016) 5:1541 is reported to be 15–40 % in patients who undergo major abdominal or pelvic surgery resulting in 0.2–0.9 % rate of fatal pulmonary embolism (PE) event (Geerts et al 2008; Mismetti et al 2001)
The risk of postoperative deep venous thrombosis (DVT) is highest within the 1st week or two after surgery, VTE complications including fatal PE may occur later, with a peak reported between days 14 and 28 by some authors (Van Hemelrijck et al 2013)

Summary

Introduction

Venous thromboembolism (VTE) is a major health care problem resulting in significant mortality, morbidity and increase in medical expenses. It is recognized to be a major global health care problem resulting in significant mortality, Surgery is a major risk factor of VTE. Cancer is a well- documented risk factor for VTE, elevating its risk four to sevenfold when compared to the risk in cancer free patients (Heit et al 2000). The risk of postoperative DVT is highest within the 1st week or two after surgery, VTE complications including fatal PE may occur later, with a peak reported between days 14 and 28 by some authors (Van Hemelrijck et al 2013)

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Conclusion