The AVAIL ME study: a multinational survey of VTE risk and prophylaxis
Tóm tắt
Venous thromboembolism (VTE) is a major public health issue that is frequently underestimated. The primary objective of this multinational survey was to identify patients at risk for VTE, and to define the rate of patients receiving appropriate prophylaxis in the Middle Eastern region. Standardized case report forms were filled by trained individuals on one predefined day in selected hospitals. Data were then entered and analyzed by independent biostatisticians. Risk was categorized according to American College of Chest Physicians (ACCP) guidelines, 2004. Logistic regressions were carried out to assess factors that determined VTE prophylaxis. 845 (37%) medical and 1421 (63%) surgical patients were eligible for the study. Patients were at low (4.2%), moderate (51.7%), high (9%) and very high risk (35.2%) for VTE. Any VTE prevention was given in 17.9, 41.7, 60.6 and 66.9% of respective risk categories, while ACCP guidelines were applied in 86.3, 41.1, 48.3 and 24.5% of these categories. Surgical patient type, immobility on admission, and contraceptive use were the most important drivers of VTE prophylaxis in those who were eligible to it (OR ≥ 2). Surgical patient type, immobility during hospitalization, existence of a VTE protocol and chronic heart failure were the most important drivers for VTE prophylaxis application in patients who were not eligible for it (OR ≥ 3). A concordance κ value of 0.16 was found between eligibility for VTE prophylaxis on one hand and its application in practice (P < 0.001). Risk factors for VTE and eligibility for VTE prophylaxis are common, but VTE prophylaxis and guidelines application are low.
Tài liệu tham khảo
Heit JA, Mohr DN, Silverstein MD, Petterson TM, O’Fallon WM, Melton LJ 3rd (2000) Predictors of recurrence after deep vein thrombosis and pulmonary embolism: a population-based cohort study. Arch Intern Med 160:761–768
Nordström M, Lindblad B, Bergqvist D, Kjellström T (1992) A prospective study of the incidence of deep-vein thrombosis within a defined urban population. J Intern Med 232:155–160
Oger E (2000) Incidence of venous thromboembolism: a community-based study in Western France. EPI-GETBP Study Group. Groupe d’Etude de la Thrombose de Bretagne Occidentale. Thromb Haemost 83:657–660
Geerts WH, Pineo GF, Heit JA et al (2004) Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 126:338S–400S
Arcelus JI, Caprini JA, Monreal M, Suárez C, González-Fajardo J (2003) The management and outcome of acute venous thromboembolism: a prospective registry including 4011 patients. J Vasc Surg 38:916–922
Cohen AT, Agnelli G, Anderson FA, VTE Impact Assessment Group in Europe (VITAE) et al (2007) Venous thromboembolism (VTE) in Europe.The number of VTE events and associated morbidity and mortality. Thromb Haemost 98:756–764
Clagett GP, Anderson FA Jr, Geerts W et al (1998) Prevention of venous thromboembolism. Chest 114:531S–560S
Anderson FA Jr, Wheeler HB, Goldberg RJ et al (1991) A population-based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism: the Worcester DVT Study. Arch Intern Med 151:933–938
Anderson FA Jr, Wheeler HB (1995) Venous thromboembolism: risk factors and prophylaxis. Clin Chest Med 16:235–251
White RH, Romano PS, Zhou H, Rodrigo J, Bargar W (1998) Incidence and time course of thromboembolic outcomes following total hip or knee arthroplasty. Arch Intern Med 158:1525–1531
Dahl OE, Gudmundsen TE, Haukeland L (2000) Late occurring clinical deep vein thrombosis in joint-operated patients. Acta Orthop Scand 71:47–50
Arcelus JI, Monreal M, Caprini JA, RIETE Investigators et al (2008) Clinical presentation and time-course of postoperative venous thromboembolism: results from the RIETE Registry. Thromb Haemost 99:546–551
Spencer FA, Lessard D, Emery C, Reed G, Goldberg RJ (2007) Venous thromboembolism in the outpatient setting. Arch Intern Med 167:1471–1475
Sullivan SD, Kahn SR, Davidson BL, Borris L, Bossuyt P, Raskob G (2003) Measuring the outcomes and pharmacoeconomic consequences of venous thromboembolism prophylaxis in major orthopaedic surgery. Pharmacoeconomics 21:477–496
Second Thromboembolic Risk Factors (THRiFT II) Consensus Group (1998) Risk of and prophylaxis for venous thromboembolism in hospital patients. Phlebology 13:87–97
Geerts WH, Heit JA, Clagett GP et al (2001) Prevention of venous thromboembolism. Chest 119:132S–175S
Hirsh J, Guyatt G, Albers GW, Harrington R, Schünemann HJ, American College of Chest Physician (2008) Antithrombotic and thrombolytic therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th edition). Chest 133:110S–112S
Nicolaides AN, Breddin HK, Fareed J, Cardiovascular Disease Educational, Research Trust, the International Union of Angiology et al (2001) Prevention of venous thromboembolism: international consensus statement. Guidelines compiled in accordance with the scientific evidence. Int Angiol 20:1–37
Fletcher J, MacLellan D, Fisher C (1998) Management and prevention of venous thromboembolism: guidelines for practice in Australia and New Zealand. MediMedia Communications, Sydney, Australia
Rogers F, Cipolle M, Velmahos G, Rozycki G, Luchette FA (2002) Practice management guidelines for the prevention of venous thromboembolism in trauma patients: the EAST practice management guidelines work group. J Trauma 53:142–164
Macklon N, Greer A (1995) Thromboprophylaxis in obstetrics and gynaecology (PACE no. 95/10). Royal College of Obstetricians and Gynaecologists, London, UK
Tooher R, Middleton P, Pham C et al (2005) A systematic review of strategies to improve prophylaxis for venous thromboembolism in hospitals. Ann Surg 241:397–415
Cohen A, Tapson V, Bergmann JF, ENDORSE Investigators et al (2008) Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet 371:387–394
Kurtoğlu M, Büyükkurt CD, Kurtoğlu M, Dural CA, Güloğlu R, Akar U (2003) Venous thromboembolism prophylaxis with low molecular weight heparins in polytraumatized patients in intensive care unit (extended serie). Ulus Travma Acil Cerrahi Derg 9:37–44
Elis A, Ellis MH (2004) Preventing venous thromboembolism in acute medical patients. QJM 97:797–801
Abba AA, Al Ghonaim MA, Rufai AM (2004) Physicians’ practice for prevention of venous thromboembolism in medical patients. J Coll Physicians Surg Pak 14:211–214
Masroujeh R, Shamseddeen W, Isma’eel H, Otrock ZK, Khalil IM, Taher A (2008) Underutilization of venous thromboemoblism prophylaxis in medical patients in a tertiary care center. J Thromb Thrombolysis 26:138–141
Zeitoun AA, Dimassi HI, El Kary DY, Akel MG (2009) An evaluation of practice pattern for venous thromboembolism prevention in Lebanese hospitals. J Thromb Thrombolysis 28:192–199
Awidi A, Obeidat N, Magablah A, Bsoul N (2009) Risk stratification for venous thromboembolism in hospitalized patients in a developing country: a prospective study. J Thromb Thrombolysis 28:309–313
Motykie GD, Zebala LP, Caprini JA (2000) A guide to venous thromboembolism risk factor assessment. J Thromb Thrombolysis 9:253–262
Rothman KJ, Greenland S, Lash TL (2008) Modern epidemiology, 3rd ed. Williams & Wilkins, Lippincott
Goldhaber SZ, Tapson VF (2004) A prospective registry of 5451 patients with ultrasound-confirmed deep vein thrombosis. Am J Cardiol 93:259–262
Geerts WH, Selby R (2003) Prevention of venous thromboembolism in the ICU. Chest 124:357S–363S
Piazza G, Seddighzadeh A, Goldhaber S (2007) Double trouble for 2, 609 hospitalized medical patients who developed deep vein thrombosis: prophylaxis omitted more often and pulmonary embolism more frequent. Chest 132:554–561
Ageno W, Turpie AG (2002) Deep venous thrombosis in the medically ill. Curr Hematol Rep 88:73–78
Deheinzelin D, Braga AL, Martins LC, Martins MA, Hernandez A, Yoshida WB, the Trombo Risc Investigators (2006) Incorrect use of thromboprophylaxis for venous thromboembolism in medical and surgical patients: results of a multicentric, observational and cross-sectional study in Brazil. J Thromb Haemost 4:1266–1270
Ouro-Bang’na Maman AF, Agbétra N, Abalo A, Egbohou P, Tomta K, Chobli M (2006) Practice of the thromboembolic disease prophylaxis: a survey among surgeons and anaesthetists in Togo. Ann Fr Anesth Reanim 25:1107–1110
Kakkar AK, Cohen AT, Tapson VF, Bergmann JF, Goldhaber SZ, Deslandes B, Huang W, Anderson FA Jr, ENDORSE Investigators (2010) Venous thromboembolism risk and prophylaxis in the acute care hospital setting (ENDORSE survey): findings in surgical patients. Ann Surg 251:330–338
Lyman GH, Khorana AA, Falanga A, Clarke-Pearson D, Flowers C, Jahanzeb M, the American Society of Clinical Oncology (2007) American Society of Clinical Oncology guideline: recommendations for venous thromboembolism prophylaxis and treatment in patients with cancer. J Clin Oncol 25:5490–5505
Amin A, Stemkowski S, Lin J, Yang G (2008) Appropriate thromboprophylaxis in hospitalized cancer patients. Clin Adv Hematol Oncol 6:910–920
Kahn SR, Panju A, Geerts W, Pineo GF, Desjardins L, Turpie AG, CURVE study investigators (2007) Multicenter evaluation of the use of venous thromboembolism prophylaxis in acutely ill medical patients in Canada. Thromb Res 119:145–155
Dentali F, Riva N, Gianni M, Malato A, Bozzato S, Bernasconi M et al (2008) Prevalence of renal failure and use of antithrombotic prophylaxis among medical inpatients at increased risk of venous thromboembolic events. Thromb Res 123:67–71
Ansari K, Dalal K, Patel M (2007) Risk stratification and utilisation of thrombo-embolism prophylaxis in a medical-surgical ICU: a hospital-based study. J Indian Med Assoc 105:536–540
Tincani E, Crowther MA, Turrini F, Prisco D (2007) Prevention and treatment of venous thromboembolism in the elderly patient. Clin Interv Aging 2:237–246
Tapson VF, Decousus H, Pini M, Chong BH, Froehlich JB, Monreal M, the IMPROVE Investigators (2007) Venous thromboembolism prophylaxis in acutely ill hospitalized medical patients: findings from the International Medical Prevention Registry on Venous Thromboembolism. Chest 132:936–945
Huang A, Barber N, Northeast A (2000) Deep vein thrombosis prophylaxis protocol: needs active enforcement. Ann R Coll Surg Engl 82:69–70
Golhaber S (2006) Prevention of venous thromboembolism. Kardiovaskuläre Medizin 9:102–108
Baroletti S, Munz K, Sonis J, Fanikos J, Fiumara K, Paterno M et al (2008) Electronic alerts for hospitalized high-VTE risk patients not receiving prophylaxis: a cohort study. J Thromb Thrombolysis 25:146–150
Birks M, Aiono S, Magee T et al (2002) A simple way to improve DVT protocol compliance. Phlebology 16:121–124
Dobesh PP, Stacy ZA (2005) Effect of a clinical pharmacy education program on improvement in the quantity and quality of venous thromboembolism prophylaxis for medically ill patients. J Manag Care Pharm 11:755–762
Bauer JB, Chun DS, Karpinski TA (2008) Pharmacist-led program to improve venous thromboembolism prophylaxis in a community hospital. Am J Health Syst Pharm 65:1643–1647
Shorr AF, Jackson WL, Weiss BM, Moores LK (2007) Low-molecular weight heparin for deep vein thrombosis prophylaxis in hospitalized medical patients: results from a cost-effectiveness analysis. Blood Coagul Fibrinolysis 18:309–316
Nijkeuter M, Huisman MV (2004) Pentasaccharides in the prophylaxis and treatment of venous thromboembolism: a systematic review. Curr Opin Pulm Med 10:338–344
Warkentin T (2002) Current agents for the treatment of patients with heparin-induced thrombocytopenia. Pulm Med 8:405–412
Motsch J, Walther A, Bock M, Böttiger BW (2006) Update in the prevention and treatment of deep vein thrombosis and pulmonary embolism. Curr Opin Anaesthesiol 19:52–58