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Evaluation of venous thromboembolism prophylaxis in a major hospital in a developing country

International Journal of Clinical Pharmacy volume 39, pages 881–887 (2017)Cite this article

Abstract

Background Venous thromboembolism is the most common preventable cause of hospital death. Despite that, there is still a large gap between what we know about venous thromboembolism prophylaxis and what is happening in current practice. Objective To evaluate VTE prophylaxis in Al-Basheer hospital and assess the extent of agreement of physicians’ practice with the guidelines. Setting Al-Basheer governmental hospital in Jordan between January 2016 and June 2016. Method In this cross-sectional observational study, patients were randomly selected from medical and surgical wards. The need for venous thromboembolism prophylaxis was assessed according to the American College of Chest Physicians guideline (9th edition) for men and non-pregnant women, and the Royal College of Obstetricians and Gynecologists guidelines for pregnant women. Main outcome measure: rate of agreement of venous thromboembolism prophylaxis with the guidelines. Results The total number of patients was 1030, Patients in the medical wards constituted most of the participants. The rate of concordance with the guidelines was 718/1030 (69.7%) in the total number of patients When the patients were divided into groups: those that required venous thromboembolism prophylaxis and those that did not, the rate of agreement with guidelines in the subgroup that needed prophylaxis 160/456 (35.1%) was lower than the rate in the subgroup that did not need prophylaxis 558/574 (97.2%), p value <0.001. Conclusion venous thromboembolism prophylaxis in Al-Basheer hospital is not appropriate and underused, this might be attributed to the absence of an institutional guideline.

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References

  1. Heit JA, Melton LJ 3rd, Lohse CM, Petterson TM, Silverstein MD, Mohr DN, et al. Incidence of venous thromboembolism in hospitalized patients vs community residents. Mayo Clin Proc. 2001;76(11):1102–10.

    CAS  Article  PubMed  Google Scholar 

  2. Dobesh PP. Economic burden of venous thromboembolism in hospitalized patients. Pharmacotherapy. 2009;29(8):943–53.

    Article  PubMed  Google Scholar 

  3. Mismetti P, Laporte-Simitsidis S, Tardy B, Cucherat M, Buchmuller A, Juillard-Delsart D, et al. Prevention of venous thromboembolism in internal medicine with unfractionated or low-molecular-weight heparins: a meta-analysis of randomised clinical trials. Thromb Haemost. 2000;83(1):14–9.

    CAS  PubMed  Google Scholar 

  4. Kahn SR, Panju A, Geerts W, Pineo GF, Desjardins L, Turpie AGG, et al. Multicenter evaluation of the use of venous thromboembolism prophylaxis in acutely ill medical patients in Canada. Thromb Res. 2007;119(2):145–55.

    CAS  Article  PubMed  Google Scholar 

  5. Mokhtari M, Salameh P, Kouchek M, Kashani BS, Taher A, Waked M. The AVAIL ME Extension: a multinational Middle Eastern survey of venous thromboembolism risk and prophylaxis. J Thromb Haemost. 2011;9(7):1340–9.

    CAS  Article  PubMed  Google Scholar 

  6. Gharaibeh L, Albsoul-Younes A, Younes N. Evaluation of VTE prophylaxis in an educational hospital: comparison between the institutional guideline (Caprini 2006) and the ACCP guideline (ninth edition). Clin Appl Thromb Hemost. 2016;22(7):627–32.

  7. Hajian-Tilaki K. Sample size estimation in epidemiologic studies. Caspian J Intern Med. 2011;2(4):289–98.

    PubMed  PubMed Central  Google Scholar 

  8. Kahn SR, Lim W, Dunn AS, Cushman M, Dentali F, Akl EA, et al. Prevention of VTE in nonsurgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e195S–226S.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  9. Gould MK, Garcia DA, Wren SM, Karanicolas PJ, Arcelus JI, Heit JA, et al. Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e227S–77S.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  10. Reducing the Risk of Venous Thromboembolism during Pregnancy and the Puerperium. Royal college of Obstetricians and Gynaecologists. 2015. https://www.rcog.org.uk/globalassets/documents/guidelines/gtg-37a.pdf. Accessed January 16th 2016.

  11. Cohen AT, Tapson VF, Bergmann JF, Goldhaber JF, Kakkar AK, Deslandes B, et al. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet (London, England). 2008;371(9610):387–94.

  12. Vazquez F, Watman R, Tabares A, Gumpel C, Baldessari E, Vilaseca AB, et al. Risk of venous thromboembolic disease and adequacy of prophylaxis in hospitalized patients in Argentina: a multicentric cross-sectional study. Thrombosis J. 2014;12(1):1–8.

    Article  Google Scholar 

  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.

  14. Awidi A, Obeidat N, Magablah A, Bsoul N. Risk stratification for venous thromboembolism in hospitalized patients in a developing country: a prospective study. J Thromb Thrombolysis. 2009;28(3):309–13.

    Article  PubMed  Google Scholar 

  15. Anderson FA, Spencer FA. Risk Factors for venous thromboembolism. Circulation. 2003;107(23 suppl 1):I-9-I-16.

    Google Scholar 

  16. Ageno W, Squizzato A, Ambrosini F, Dentali F, Marchesi C, Mera V, et al. Thrombosis prophylaxis in medical patients: a retrospective review of clinical practice patterns. Haematologica. 2002;87(7):746–50.

  17. Heit JA, O’Fallon WM, Petterson TM, Lohse CM, Silverstein MD, Mohr DN, et al. Relative impact of risk factors for deep vein thrombosis and pulmonary embolism: a population-based study. Arch Intern Med. 2002;162(11):1245–8.

    Article  PubMed  Google Scholar 

  18. Heit JA, Kobbervig CE, James AH, Petterson TM, Bailey KR, Melton LJ 3rd. Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30-year population-based study. Ann Intern Med. 2005;143(10):697–706.

    Article  PubMed  Google Scholar 

  19. Tooher R, Middleton P, Pham C, Fitridge R, Rowe S, Babidge W, et al. A systematic review of strategies to improve prophylaxis for venous thromboembolism in hospitals. Ann Surg. 2005;241(3):397–415.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Kahn SR, Morrison DR, Cohen JM, Emed J, Tagalakis V, Roussin A, et al. Interventions for implementation of thromboprophylaxis in hospitalized medical and surgical patients at risk for venous thromboembolism. Cochrane Database Syst Rev. 2013;(7):Cd008201.

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Acknowledgements

The research team would like to thank medical teams in the different wards in Al Basheer hospital for their cooperation.

Funding

No funding was provided from any source for this research.

Conflicts of interest

The authors would like to declare that they have no conflicts of interest to disclose.

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Affiliations

  1. Department of Clinical Pharmacy and Bio-pharmaceutics, School of Pharmacy, University of Jordan, Amman, Jordan

    Lubna Gharaibeh

  2. Pharmacy Department, Al-Basheer Government Hospital, Amman, Jordan

    Hanan Sartawi, Diana Ayyad, Tareq Juma, Kamal Albassoumi & Enas Ismail

Authors
  1. Lubna Gharaibeh
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  2. Hanan Sartawi
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  3. Diana Ayyad
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  4. Tareq Juma
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  5. Kamal Albassoumi
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  6. Enas Ismail
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Corresponding author

Correspondence to Lubna Gharaibeh.

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Gharaibeh, L., Sartawi, H., Ayyad, D. et al. Evaluation of venous thromboembolism prophylaxis in a major hospital in a developing country. Int J Clin Pharm 39, 881–887 (2017). https://doi.org/10.1007/s11096-017-0494-7

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  • DOI: https://doi.org/10.1007/s11096-017-0494-7

Keywords

  • Anticoagulants
  • Jordan
  • Prophylaxis
  • Risk assessment
  • Venous thromboembolism