Thromboprophylaxis practice in teaching hospital settings

ABSTRACT

Venous thromboembolism [VTE] is known to be a major cause of morbidity and mortality among hospitalized patients. The American College of Chest Physicians [ACCP] published their seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy in 2004, with recommendations for venous thromboembolism prophylaxis. Despite these recommendations, appropriate thrompoprophylaxis is underused. This study was performed to examine the frequency and adequacy of thromboprophylaxis in hospitalized patients in three primary-tertiary teaching hospitals in Urmia, Iran. We carried out a cross-sectional prospective study on 436 patients hospitalized in three teaching hospitals in Urmia, Iran. Information was obtained from medical-nursing records and patient observation and was compared with the recommended guidelines of the ACCP. The appropriateness of diagnoses was not evaluated. Of 436 patients, 352 subjects required thromboprophylaxis and the total proportion of them who underwent some form of thromboprophylaxis was 16.7% with only 9.9% receiving ACCP recommended prophylaxis. Prophylaxis rate was 29.7% in medical wards, 27.8% in ICU, 11.0% in surgical wards overall and14.7% postoperatively. Low dose heparin was the most common type of prophylaxis. Despite the widely disseminated, evidence-based recommendations, venous thromboembolism prophylaxis is underused in our hospitals. It is more commonly neglected in our hospitals than those in Western countries. We think that in most other developing countries, this condition is similar. Therefore, the consensus statements alone are insufficient to ensure the routine use of prophylactic strategies in clinical practice. In addition to the statements, other strategies are required to solve the problem: