Adherence to Thromboprophylaxis Guidelines in Acutely ill and Immobilized patients: A Clinical Audit
DOI:
https://doi.org/10.47489/szmc.v39i2.582Keywords:
Venous Thromboembolism, Thromboprophylaxis, Medical Ward, Evidence based guidelinesAbstract
Background: Thromboprophylaxis is a proven and safe strategy for hospitalized patients. However, many hospitals still don’t use these preventive measures enough, despite their benefits.
Objective: To evaluate the risk and adoption of thromboprophylaxis guidelines in acutely ill and immobilized patients in a tertiary care hospital.
Method: This prospective observational study was conducted in the medical wards of Hayatabad Medical Complex (HMC), Peshawar from April 2021 to September 2022. A total of 4260 patients were hospitalized in medical wards during the study period. The simple random sampling technique allowed the inclusion of 600 patients with equal representation from all the three medical units of HMC.
Results: Among the admitted patients, 336 (56%) were females while 264 (44%) were males. Patients stratified as High Risk were 435 (72%) while the remaining 165 (28%) were in Low-risk group. Total 345 (57.5%) patients received Venous thromboembolism (VTE) prophylaxis with 187 (31.2%) in the High-Risk group while 158 (26.4%) in the low-risk group. Amongst these74 (12.3%) patients received both the modalities Thromboembolic Deterrent (TED) Stockings and anticoagulation therapy while remaining 173 (28.6%) received TED Stockings alone, and 101 (16.7%) received anticoagulation therapy alone. Implementation of VTE prophylaxis is estimated to be 31.2% in high-risk group and 26.4% in low-risk group patients.
Conclusion: Present investigation revealed substantial underutilization of venous thromboembolisms prophylaxis to seriously ill medical ward patients and emphasize the urgent requirement for amended implementation of current guidelines in hospitals, so as to ensure optimal venous thromboprophylaxis practices and prevent avoidable cases of venous thromboembolism.
References
Skeik N, Westergard E. Recommendations for VTE Prophylaxis in Medically Ill Patients. Ann Vasc Dis. 2020 Mar 25;13(1):38-44. doi:10.3400/avd.ra.19-00115. PMID: 32273920; PMCID: PMC7140153.https://doi.org/10.3400/avd.ra.19-00115
Bartlett MA, Mauck KF, Stephenson CR, Ganesh R, Daniels PR. Perioperative venous thromboembolism prophylaxis. In Mayo Clinic Proceedings 2020; 95(12): 2775-2798 doi.org/10.1016/j.mayocp.2020.06.015 ttps://doi.org/10.1016/j.mayocp.2020.06.015
Segon YS, Summey RD, Slawski B, Kaatz S. Surgical venous thromboembolism prophylaxis: clinical practice update. Hospital Practice 2020; 48(5):248-57.doi: 10.1097/CCM.0000000000004466https://doi.org/10.1097/CCM.0000000000004466
Nkoke C, Tchinde Ngueping MJ, Atemkeng F, Teuwafeu D, Boombhi J, Menanga A. Incidence of Venous Thromboembolism, Risk Factors and Prophylaxis in Hospitalized Patients in the South West Region of Cameroon. Vasc Health Risk Manag. 2020 Jul 22;16:317-324. doi: 10.2147/VHRM.S205935.https://doi.org/10.2147/VHRM.S205935
Onwuzo C, Olukorode J, Sange W, Tanna SJ, Osaghae OW, Hassan A, Kristilere H, Orimoloye DA, Omokore O, Ganiyu B, Fayemi T, Addeh E. A Review of the Preventive Strategies for Venous Thromboembolism in Hospitalized Patients. Cureus. 2023 Nov 7;15(11):e48421. doi: 10.7759/cureus.48421. PMID: 38074047; PMCID: PMC10701607.https://doi.org/10.7759/cureus.48421
Nicholson M, Chan N, Bhagirath V, Ginsberg J. Prevention of Venous Thromboembolism in 2020 and Beyond. J Clin Med. 2020 Aug 1;9(8):2467. doi: 10.3390/jcm9082467. PMID: 32752154; PMCID: PMC7465935https://doi.org/10.3390/jcm9082467
Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR, Colwell CW. Prevention of venous thromboembolism: American College of Chest Physicians Evidence- Based Clinical Practice Guidelines (8th Edition). Chest. 2008 Jun;133(6 Suppl):381S-453S. doi:10.1378/chest.08-0656. PMID:18574271https://doi.org/10.1378/chest.08-0656
Stevens SM, Woller SC, Kreuziger LB, Bounameaux H, Doerschug K, Geersing GJ, Huisman MV, Kearon C, King CS, Knighton AJ, Lake E. Antithrombotic therapy for VTE disease: second update of the CHEST guideline and expert panel report. Chest. 2021 Dec 1;160(6):e545-608.https://doi.org/10.1016/j.chest.2021.07.055
Stashenko GJ, Tapson VF. Prevention of venous thromboembolism in medical patients and outpatients. Nat Rev Cardiol. 2009;6:356–363.https://doi.org/10.1038/nrcardio.2009.33
Alckmin CA, Garcia MD, Bricola SA, Martins Mde A, Lichtenstein A, Paiva EF. Venous thromboembolism risk assessment in hospitalised patients: a new proposal. Clinics (Sao Paulo). 2013 Nov;68(11):1416-20.doi:10.6061/clinics/2013(11)06. https://doi.org/10.6061/clinics/2013(11)06
Schaefer JK, Grant PJ. A need to refine venous thromboembolism risk assessment: the challenge of optimizing patient selection for thromboprophylaxis among hospitalized adults. Res Pract Thromb Haemost. 2023 Nov 9;7(8):102258. doi: 10.1016/j.rpth.2023.102258.https://doi.org/10.1016/j.rpth.2023.102258
Becker, Richard C, and Frederick A Spencer, 'Venous Thromboembolism Prophylaxis', Fibrinolytic and Antithrombotic Therapy: Theory, Practice, and Management, Second Edition (New York, 2006; online edn, Oxford Academic, 12 Nov. 2020), https://doi.org/10.1093/oso/9780195155648.003. 0030, accessed 26 Aug. 2024.https://doi.org/10.1093/oso/9780195155648.003.0030
Gibbs H, Fletcher J, Blombery P, Collins R, Wheatley D. Venous thromboembolism prophylaxis guideline implementation is improved by nurse directed feedback and audit. Thromb J. 2011 Apr 5;9(1):7. doi: 10.1186/1477- 9560-9-7. PMID: 21466681; PMCID: PMC3080276. https://doi.org/10.1186/1477-9560-9-7
Ambra N, Mohammad OH, Naushad VA, Purayil NK, Mohamedali MG, Elzouki AN, Khalid MK, Illahi MN, Palol A, Barman M, Sharif M, Chalihadan S, Punnorath A, Mostafa A, Al Hariri B, Khidir TGM, Varikkodan I. Venous Thromboembolism Among Hospitalized Patients: Incidence and Adequacy of Thromboprophylaxis - A Retrospective Study. Vasc Health Risk Manag. 2022 Jul 24;18:575-587. doi: 10.2147/VHRM.S370344. PMID:35912018; PMCID: PMC9333096.https://doi.org/10.2147/VHRM.S370344
Kharaba A, Al Aboud M, Kharabah MR, Alyami K, Al Beihany A. Venous thromboembolism risks and prophylaxis in King Fahad Hospital, Madinah, Saudi Arabia. J Epidemiol Glob Health.2017;7(4):295 298.doi:10.1016/j.jegh.2017.09.003 https://doi.org/10.1016/j.jegh.2017.09.003
Al-Hameed FM, Al-Dorzi HM, Qadhi AI, et al. Thromboprophylaxis and mortality among patients who developed venous thromboembolism in seven major hospitals in Saudi Arabia. Ann Thorac Med. 2017;12(4):282–289. doi: 10.4103/atm.ATM_101_17 https://doi.org/10.4103/atm.ATM_101_17
Alsayegh F, Kamaliddin H, Sheshah E, Bukhamseen N, Alkhuwaitir T, Elhoufi A. Assessment of venous thromboembolism risk and adequacy of prophylaxis in selected acute care medical centres in Arabian Gulf States: results from the ENDORSE study. Med Princ Pract. 2012;21(6):522–528. doi: 10.1159/000339081 https://doi.org/10.1159/000339081
Tapson VF, Decousus H, Pini M, et al. Venous thromboembolism prophylaxis in acutely ill hospitalized medical patients: findings from the international medical prevention registry on venous thromboembolism.Chest. 2007;132(3):936–945. doi: 10.1378/chest.06-2993 https://doi.org/10.1378/chest.06-2993
Kahn SR, Panju A, Geerts W, et al. Multicenter evaluation of the use of venous thromboembolism prophylaxis in acutely ill medical patients in Canada. Thromb Res. 2007;119(2):145–155.doi:10.1016/j.thromres.2006.01.011https://doi.org/10.1016/j.thromres.2006.01.011
Khoury H, Welner S, Kubin M, Folkerts K, Haas S. Disease burden and unmet needs for prevention of venous thromboembolism in medically ill patients in Europe show underutilisation of preventive therapies. Thromb Haemost. 2011;106(4):600–608.doi: 10.1160/TH11-03-0168https://doi.org/10.1160/TH11-03-0168
Farfan M, Bautista M, Bonilla G. Worldwide adherence to ACCP guidelines for thromboprophylaxis after major orthopedic surgery: A systematic review of the literature and meta-analysis. Thrombosis Research 2016; 141:163-170. doi:10.1016/j.thromres.2016.03.029https://doi.org/10.1016/j.thromres.2016.03.029
Shah MH, Khan MS, Ahmad S, Aftab U, Khan A, Ahmad W, Iftikhar U, Ahmad I. Risk Assessment and Prophylaxis of Venous Thromboembolism in Patients of Medical Ward of Northwest General Hospital and Research Center, Peshawar, Pakistan: A Quality Improvement Project. Cureus. 2022 Dec 22;14(12):e32811. doi: 10.7759/cureus.32811. PMID: 36699801; PMCID: PMC9870187.https://doi.org/10.7759/cureus.32811
Abuowda Y, Alswerki M, Alsheikh Ahmad A, et al. Pharmacological prophylaxis of venous thromboembolism in adult medical and surgical wards in the Gaza Strip: a multi-centre clinical audit. Lancet. 2019;393:1.http://dx.doi.org/10.13140/RG.2.2.22085.96482
E Ismail A, Jadawji N, Adebayo P, et al. Evaluation of venous thromboembolism (VTE) risk assessment and thrombo-prophylaxis practices in hospitalized medical and surgical patients at Aga Khan Hospital Dar es Salaam: single-centre retrospective study. Pan Afr Med J. 2022;42:160.https://doi.org/10.11604/pamj.2022.42.160.28278
Kahn SR, Morrison DR, Cohen JM, Emed J, Tagalakis V, Roussin A, Geerts W. Interventions for implementation of thromboprophylaxis in hospitalized medical and surgical patients at risk for venous thromboembolism. Cochrane Database Syst Rev. 2013 Jul 16;(7):CD008201.doi:10.1002/14651858.CD008201.pub2. Update in:Cochrane Database Syst Rev. 2018 Apr 24;4:CD008201.doi:10.1002/14651858.CD008201.pub3. PMID:23861035. https://doi.org/10.1002/14651858.CD008201.pub3
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