Quality of venous thromboembolism prophylaxys in a university hospital in Brazil
DOI:
https://doi.org/10.11606/issn.1679-9836.v99i1p1-7Keywords:
Thrombosis, Venous thromboembolism, Disease prevention, Hospitalization, Prescriptions, Anticoagulants, Pulmonary embolism;, HeparinAbstract
Objective: Though recommended, prophylaxis for venous thromboembolism is not always correctly prescribed. In light of this fact, our objective is to evaluate the quality of medical prescriptions with regards to venous thromboembolism prophylaxis in a brazilian teaching hospital. Methods: During a 30-day period, medical prescriptions to patients treated at the internal medicine ward, surgery ward and at the intensive care unit were assessed. Patients on anticoagulants for a non-prophylactic reason were excluded. This cross-sectional analysis evaluated the appropriateness of venous thromboembolism prophylaxis based on the 9th Guideline of the American College of Chest Physicians. Results: 358 prescriptions have been firstly assessed, of which 65 were excluded. Out of 293 selected prescriptions, 106 (36.2%) were considered inaccurate. The main cause of inadequacy was underprescription, which was observed in 72 cases (67.9%). Surgery wards accounted for the majority of inaccurate precriptions (48.72%) compared to internal medicine (35.11%) and critical care ones (26.2%) (p=0.0013). Conclusion: Alarming rates of inadequate prescriptions regarding venous thromboembolism prophylaxis were found. Underprescription was the main cause of inadequacy. Surgery wards were responsible for most of the imprecision. Further interventions are required in order to improve this important and safe medical practice for hospitalized patients.
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References
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25. Bergqvist D, Lindgren B, Matzsch T. Comparison of the cost of preventing postoperative deep vein thrombosis with either unfractionated or low molecular weight heparin. Br J Surg. 1996;83(11):1548-52. doi: 10.1002/bjs.1800831117.
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27. Kucher. N, Koo. S, Quiroz. R, Cooper JM, Paterno MD, Soukonnikov B, et al. Eletronic alerts to prevent venous thromboembolism among hospitalized patients. N Eng J Med. 2010;363(1):1-3. doi: 10.1056/NEJMoa041533.
28. Hirsh J, Guyatt G, Alberts GW, Schünemann HJ. The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy: Evidence-Based Guidelines. Chest. 2004;126(3 Suppl):172-3. doi: 10.1378/chest.126.3_suppl.172S.
29. Wickstrom G, Bendix T. The “Hawthorne effect” - what did the original Hawthorne studies actually show? Scand J Work Environ Health. 2000;26(4):363-7. doi:10.5271/sjweh.555.
2. Heit JA. Epidemiology of venous thromboembolism. Nat Rev Cardiol. 2015;12(8):464-74. doi: 10.1038/nrcardio.2015.83.
3. Heit JA, Silverstein MD, Mohr DN, Petterson TM, O’Fallon WM, Melton LJ. Risk factors for deep vein thrombosis and pulmonary embolism. Arch Intern Med. 2000;160(6):809. doi: 10.1001/archinte.160.6.809.
4. Anderson FA, Wheeler HB, Goldberg RJ, Hosmer DW, Parwardhan NA, Jovanovic B, et al. 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. 1991;151(5):933-8. doi: 10.1001/archinte.1991.00400050081016.
5. Sandler DA, Martin JF. Autopsy proven pulmonary embolism in hospital patients: are we detecting enough deep vein thrombosis? J R Soc Med. 1989;82(4):203-5. doi: 10.1177/014107688908200407.
6. Amin NA, Lin J, Johnson BH, Schulman KL. Clinical and economic outcomes with appropriate or partial prophylaxis. Thromb Res. 2010;125(6):513-25. doi: 10.1016/j.thromres.2009.10.018.
7. Cohoon KP, Leibson CL, Ransom JE, Ashrani AA, Petterson TM, Long KH, et al. Costs of venous thromboembolism associated with hospitalization for medical ilness. Am J Manag Care. 2015;21(4):e255-e263. Available from: https://www.ajmc.com/journals/issue/2015/2015-vol21-n4/costs-of-venous-thromboembolism-associated-with-hospitalization-for-medical-illness.
8. Cohen AT, Davidson BL, Gallus AS, Lassen MR, Prins MH, Tomkowski W, et al. Efficacy and safety of fondaparinux for the prevention of venous thromboembolism in older acute medical patients: randomised placebo controlled trial. BMJ. 2006;332:325. doi:10.1136/bmj.38733.466748.7C.
9. Dentali F, Douketis JD, Gianni M, Lim W, Crowther MA. Meta-analysis : anticoagulant prophylaxis to prevent symptomatic venous thromboembolism in hospitalized medical patients. Ann Intern Med. 2007;146:277-88. doi: 10.7326/0003-4819-146-4-200702200-00007.
10. Shekelle PG, Wachter RM, Pronovost PJ, et al. Making Health Care Safer II: an updated critical analysis of the evidence for patient safety practices. Rockville (MD): Agency for Healthcare Research and Quality (US); 2013. (Evidence Reports/Technology Assessments, no. 211). Available from: https://www.ncbi.nlm.nih.gov/books/NBK133369/.
11. Carneiro JLDA, Targueta GP, Marino LO. Avaliação da profilaxia do tromboembolismo venoso em hospital de grande porte. Rev Col Bras Cir. 2010;37(3):204-10. http://dx.doi.org/10.1590/S0100-69912010000300008.
12. Pitta GB, Leite TL, Silva MD, Melo CF, Calheiros GD, et al. Evaluation of the use of prophylaxis for deep venous thrombosis in a teaching hospital. J Vasc Bras. 2007;6(4):344-51. http://www.scielo.br/pdf/jvb/v6n4/en_v6n4a08.pdf.
13. Tapson VF, Decousus H, Pini M, Chong BH, Froehlich JB, Monreal 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):936-45. doi: 10.1378/chest.06-2993.
14. Lester W, Freemantle N, Begaj I, Ray D, Wood J, Pagano D. Fatal venous thromboembolism associated with hospital admission: A cohort study to assess the impact of a national risk assessment target. Heart. 2013;99(23):1734-9. doi: 10.1136/heartjnl-2013-304479.
15. Germini F, Agnelli G, Fedele M, Galli MG, Giustozzi M, Marcucci M, et al. Padua prediction score or clinical judgment for decision making on antithrombotic prophylaxis: a quasi-randomized controlled trial. J Thromb Thrombolysis. 2016;42(3):336-9. doi: 10.1007/s11239-016-1358-z.
16. Guyatt GH, Akl EA, Crowther M, Gutterman DD, Schuünemann HJ; American College of Chest Physicians Antithrombotic Therapy and Prevention of Thrombosis Panel. Executive summary: Antithrombotic therapy and prevention of thrombosis. 9th ed. American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(2 Suppl.):7-47. doi: 10.1378/chest.1412S3.
17. R Core Team. R: A Language and Environment for Statistical Computing [Internet]. Vienna, Austria; 2016. Available from: https://www.R-project.org/
18. Deheinzelin D, Braga AL, Martins LC, Martins MA, Hernandez A, Yoshida WB, et al. 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. 2006;4(6):1266-70. doi: 10.1111/j.1538-7836.2006.01981.x.
19. Pitta GBB, Gomes RR. A frequência da utilização de profilaxia para trombose venosa profunda em pacientes clínicos hospitalizados. J Vasc Bras. 2010;9(4):220-8. http://dx.doi.org/10.1590/S1677-54492010000400003.
20. Goldhaber SZ, Tapson VF. DVT FREE Steering Comittee. A prospective registry of 5,451 patients with ultrasound-confirmed deep vein thrombosis. Am J Cardiol. 2004;93(2):259-62. doi: 10.1016/j.amjcard.2003.09.057.
21. Jelic S. Direct characterization of the vascular endothelium in sleep apnea. Chest. 2011;140(6):1400-01. doi: 10.1378/chest.11-1376.
22. Arnold DM, Kahn SR, Shrier I. Missed Opportunities for Prevention of Venous Thromboembolism: an evaluation of the use of thromboprophylaxis. Chest. 2001;120:1964-71. doi: 10.1378/chest.120.6.1964.
23. McFarland L, Murray E, Harrison S, Heneghan C, Ward A, Fitzmaurice D, et al. Current practice of venous thromboembolism prevention in acute trusts: a qualitative study. BMJ Open. 2014;4e005074. doi: 10.1136/bmjopen-2014-005074.
24. Mezalek ZT, Nejjari C, Essadouni L, Serraj M, Ammouri W, Belkhadir NKZ et al. Evaluation and management of thromboprophylaxis in Moroccan hospitals at national level: the Avail-MoNa study. J Thromb Thrombolysis. 2018;46(1):113-9. doi: 10.1007/s11239-018-1657-7.
25. Bergqvist D, Lindgren B, Matzsch T. Comparison of the cost of preventing postoperative deep vein thrombosis with either unfractionated or low molecular weight heparin. Br J Surg. 1996;83(11):1548-52. doi: 10.1002/bjs.1800831117.
26. Harrington R, Ansell J. Risk-benefit assessment of anticoagulant therapy. Drug Saf. 1991;6(I):54-69. doi: 10.2165/00002018-199106010-00006.
27. Kucher. N, Koo. S, Quiroz. R, Cooper JM, Paterno MD, Soukonnikov B, et al. Eletronic alerts to prevent venous thromboembolism among hospitalized patients. N Eng J Med. 2010;363(1):1-3. doi: 10.1056/NEJMoa041533.
28. Hirsh J, Guyatt G, Alberts GW, Schünemann HJ. The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy: Evidence-Based Guidelines. Chest. 2004;126(3 Suppl):172-3. doi: 10.1378/chest.126.3_suppl.172S.
29. Wickstrom G, Bendix T. The “Hawthorne effect” - what did the original Hawthorne studies actually show? Scand J Work Environ Health. 2000;26(4):363-7. doi:10.5271/sjweh.555.
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Published
2020-02-03
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Brito, G. D. de, Fioramonte, G. da S., & Marques, G. L. (2020). Quality of venous thromboembolism prophylaxys in a university hospital in Brazil. Revista De Medicina, 99(1), 1-7. https://doi.org/10.11606/issn.1679-9836.v99i1p1-7
