Prevalence Of Venous Thromboembolism Risk Research Articles

Incidence of Venous Thromboembolism, Risk Factors and Prophylaxis in Hospitalized Patients in the South West Region of Cameroon.

BackgroundVenous thromboembolism (VTE) is a serious complication in hospitalized patients. It is associated with considerable morbidity and mortality. Therefore, its prevention is of great importance. There is paucity of data on the incidence of VTE in hospitalized patients in Cameroon. The aim of this study was to determine the incidence of symptomatic VTE, its risk factors and the proportion of patients at risk that receive thromboprophylaxis in patients hospitalized in the medical and surgical units in two hospitals in the South West Region of Cameroon.MethodsA prospective study was performed in the medical and surgical units from January to March 2018. All consecutive eligible patients admitted for at least 3 days were included. Patient profile and risk factors were recorded. Patients were followed and evaluated for signs and symptoms of VTE until discharge from hospital. Suspected VTE was confirmed using compression ultrasonography and computed tomography.ResultsA total of 314 patients were included of which 58.7% were females. The mean age was 46±17.9 years. Patients aged <40 years represented 42% of the study population. Three cases of symptomatic VTE were recorded. The incidence of symptomatic VTE was 1% (95% CI: 0.3–2.8%). The prevalence of VTE risk was 93.6% with 32.5% being at high risk. The risk was 94.6% in medical patients and 92.8% in surgical patients. Among the patients at risk, only 32.5% received thromboprophylaxis. Thromboprophylaxis was significantly higher in surgical patients compared to medical patients (45.2% versus 18.7%; p<0.0001).ConclusionThe incidence of VTE in hospitalized medical and surgical patients appeared low but likely underestimated considering the high prevalence of patients at risk of VTE coupled with the underutilization of thromboprophylaxis. Clinicians should assess risk of VTE in conjunction with the clinical situation to determine the most appropriate type of prophylaxis as well as the duration of prophylaxis for VTE.

A cross-sectional evaluation of venous thromboembolism risk and use of venous thromboembolism prophylaxis in hospitalized patients in Senegal

Venous thromboembolism is a common and preventable cause of morbidity and mortality in hospitalized patients. There is a lack of data on the distribution of risk factors and prophylaxis practices in sub-Saharan Africa. To assess the prevalence of venous thromboembolism risk in hospitalized patients and to determine the proportion of at-risk patients who receive prophylaxis. The study was a cross-sectional hospital-based survey. On the basis of the global ENDORSE methodology, patients aged≥40 years admitted to a medical ward or those aged≥18 years admitted to a surgical ward were assessed for risk of venous thromboembolism by hospital chart review. Distribution of risk factors and coverage of prophylaxis in at-risk patients were determined using the 2004 American College of Chest Physicians evidence-based consensus guidelines. From October to November 2008, 520 patients (278 medical; 242 surgical) were enrolled in 12 hospitals across Senegal. Two hundred and ninety-eight (57%) were at risk of venous thromboembolism; 152 (57.4%) medical patients and 146 (60.3%) surgical patients. Among those at risk, 48 (31.6%) medical patients and 52 (35.6%) surgical patients received a prescription for prophylaxis. Among patients without contraindication to anticoagulants, 33.8% (46/136) on medical wards and 37.5% (48/128) on surgical wards received prophylaxis. The risk of venous thromboembolism was frequent in hospitalized patients in Senegal but only a few received the recommended prophylaxis. There is a need to implement a programme to improve venous thromboembolism awareness and prophylaxis.

Results of ENDORSE-2-HUNGARIA study. Repeated assessment of the prevalence of venous thromboembolism risk and prophylaxis in acute hospital care setting

ENDORSE (Epidemiologic International Day for the Evaluation of Patients at Risk for Venous Thromboembolism in the Acute Hospital Care Setting) study in 2006, was a multinational cross-sectional survey designed to assess the prevalence of venous thromboembolism (VTE) risk in the acute hospital care setting, and to determine the proportion of at-risk patients who receive appropriate prophylaxis. From the 358 randomly selected hospitals across 32 countries in the global registry, 9 Hungarian centers were included. According to the Hungarian results, the use of appropriate prophylaxis was more common in surgical patients but much less common in medical patients comparing to the worldwide average. ENDORSE 2-HUNGARY was a local survey to compare the prophylactic habits after two years and two months time period. In both surveys, the 2004 American College of Chest Physicians (ACCP) evidence-based consensus guidelines were used to assess venous thromboembolism risk and to determine whether patients were receiving recommended prophylaxis. The one day survey ENDORSE 2-HUNGARY was repeated beside seven already audited hospitals, and in two newly recruited hospitals. A total of 886 patients were assessed for thrombosis risk on the basis of hospital chart review. Of these patients 59.0% (N=523) were judged at risk for VTE, including 100% (N=327) surgical and 35.1% (N=196) medical patients. 67.9% (N=355) of the total at-risk patients received ACCP-recommended VTE prophylaxis. Among surgical patients, 84.4% (N=276) received recommended prophylaxis compared with 40.3% (N=79) of medical patients. Results of the ENDORSE in 2006 and 2009 were compared, as well. The rate of appropriate prophylaxis use in at-risk patients did not changed significantly in surgical patients, however, a significant, 43.9% increase was found in medical patients (p=0.002), that proves the success of lectures presenting the facts and focusing to increase medical prophylaxis during the time period between the two studies. 59.7% of at-risk medical patients and 15.6% of surgical patients were unprotected against thrombosis in 2009. We should further increase the rate of at-risk patients receiving appropriate prophylaxis. We should reinforce the rationale for the increase of awareness of VTE risk in hospitalized medical patients, and to enhance the prophylaxis practice among healthcare professionals.

Results of the ENDORSE Study in Hungary: Multinational, Cross-Sectional Study to Assess the Prevalence of Venous Thromboembolism Risk and Prophylaxis in Acute Hospital Care Setting

Results of the ENDORSE Study in Hungary: Multinational, Cross-Sectional Study to Assess the Prevalence of Venous Thromboembolism Risk and Prophylaxis in Acute Hospital Care Setting

Impact of Surgery Type and Co-Morbidities on Venous Thromboembolism prophylaxis Practices in Patients Undergoing Major Surgical Procedures in Acute Care Hospitals Worldwide: A Subanalysis of Data from the ENDORSE Survey

Introduction: Despite the publication of international consensus guidelines for the provision of venous thromboembolism (VTE) prophylaxis, the recent ENDORSE survey reported that 64% of patients admitted to surgical wards in hospitals worldwide are at risk for VTE, and of those only 59% received appropriate prophylaxis (Lancet 2008; 371:387–94). In this sub-analysis of ENDORSE data, we assess the provision of VTE prophylaxis according to surgery type, and evaluate the key factors associated with the decision to provide VTE prophylaxis to surgical patients.Methods: ENDORSE was a multinational, cross-sectional survey of patients admitted to medical and surgical wards in 358 hospitals across 32 countries (Lancet 2008; 371:387–94). VTE risk and prophylaxis use were assessed in evaluable patients according to the 2004 American College of Chest Physicians (ACCP) guidelines (Chest 2004; 126:338S–400S). Major surgery was grouped into the following categories: major orthopedic (hip replacement, knee replacement, hip fracture repair); abdominal/thoracic (colon/small bowel, rectosigmoid, gastric, hepatobiliary, thoracic); vascular; urological/gynecological; and other (curative arthroscopy, other orthopedic trauma, other surgeries). Independent factors associated with the use of ACCP-recommended prophylaxis in surgical patients at risk for VTE were evaluated using multivariable logistic regression analyses.Results: Of the 30,827 patients in surgical wards included in ENDORSE, 18,461 had undergone major surgery as of the date of the survey. Of these, 17,018 (92.2%) were considered to be at risk for VTE, although only 10,710 (58.0%) received ACCP-recommended types of VTE prophylaxis. The proportion of patients at risk for VTE and the use of ACCP-recommended prophylaxis varied according to surgery type (Table). Multivariable analysis confirmed that surgery type was the factor that was most strongly associated with the provision of ACCP-recommended VTE prophylaxis. Patients undergoing major orthopedic surgery were most likely to receive recommended VTE prophylaxis, with patients undergoing hip replacement surgery 6 times more likely to receive ACCP- prophylaxis (OR 6.2; 95% CI 5.0–7.9). Curative arthroscopy and rectosigmoid surgery were also strongly associated with the provision of ACCP-recommended prophylaxis: (OR 3.6; 95% CI 2.3–5.4 and OR 2.3; 95% CI 1.7–3.0, respectively). When surgery type was excluded from the multivariable analysis, obesity (OR 1.9; 95% CI 1.7–2.1), rheumatologic or inflammatory disease (OR 1.7; 95% CI 1.3– 2.2), and previous VTE (OR 1.7; 95% CI 1.3–2.1) were the clinical characteristics most strongly associated with the use of recommended VTE prophylaxis.Conclusion: The provision of ACCP-recommended VTE prophylaxis was primarily driven by the fact that patients underwent a major operation and rates of prophylaxis use varied substantially according to the type of surgery. Patients undergoing major orthopedic surgery are most likely to receive appropriate VTE prophylaxis, however up to 45% of at-risk patients undergoing non-orthopedic procedures do not receive ACCP-recommended prophylaxis. Surgery type was the most important factor associated with the decision to provide ACCP-recommended prophylaxis in surgical patients at risk for VTE.Table: Prevalence of VTE risk and use of ACCP-recommended prophylaxis according to surgery type.Surgery typeNPatients at risk For VTE n (%)At-risk receiving ACCP-Recommended prophylaxisn (%)Major orthopedic23002300 (100)1979 (86.0)Abdominal/thoracic50284527 (90.0)3023 (66.8)Vascular1038946 (91.1)676 (71.5)Urological/gynecological26532344 (88.4)1261 (53.8)Other74426901 (92.7)3771 (54.6)

Results of ENDORSE study in Hungary. Multinational, cross-sectional study to assess the prevalence of venous thromboembolism risk and prophylaxis in acute hospital care setting

Information about the risk of venous thromboembolism and prophylactic practices around the world is limited. ENDORSE (Epidemiologic International Day for the Evaluation of Patients at Risk for Venous Thromboembolism in the Acute Hospital Care Setting) study is a multinational cross-sectional survey designed to assess the prevalence of venous thromboembolism (VTE) risk in the acute hospital care setting, and to determine the proportion of at-risk patients who receive appropriate prophylaxis. All hospital inpatients aged 40 years or above admitted to a medical ward, or those aged 18 years or above admitted to a surgical ward, in 358 randomly selected hospitals across 32 countries were assessed for risk of VTE on the basis of hospital chart review. The 2004 American College of Chest Physicians evidence-based consensus guidelines were used to assess venous thromboembolism risk and to determine whether patients were receiving recommended prophylaxis. Nine Hungarian centers were included in the international survey, and a total of 1300 patients were assessed for thrombosis risk in Hungary. Of these patients 39.9% (N=519) were judged at risk for VTE, including 58.2% (N=253) surgical and 30.8% (N=266) medical patients. 56.6% (N=294) of the total at-risk patients received ACCP-recommended VTE prophylaxis. Among major surgery patients 86.6% (N=219) received recommended prophylaxis compared with 28.2% (N=75) of medical patients. In Hungary more than two-thirds of at-risk hospitalized medical patients did not receive appropriate prophylaxis. ENDORSE results reinforced that a large proportion of hospitalized surgical and medical patients are at risk for VTE worldwide as well as in Hungary. The rate of at-risk patients receiving appropriate prophylaxis should be urgently increased.