Venous Thromboembolism Among Hospitalized Patients: Incidence and Adequacy of Thromboprophylaxis - A Retrospective Study.

Purpose: We aimed to determine the incidence of venous thromboembolism among hospitalized patients in Qatar as well as to analyze the adequacy of VTE assessment and prophylaxis in hospitalized patients. Design: Retrospective observational study. Setting: Four hospitals under Hamad Medical Corporation, Qatar. Participants: Patients over the age of 18 who were hospitalized between January 2015 and December 2019 and developed venous thromboembolism during hospitalization or within a month after discharge were included. Results: During the study period, 641,994 individuals were admitted to hospitals. The inclusion criteria were satisfied by 209 of them. The mean age was 51.25 years and 54.5% were males. Hypertension and diabetes mellitus were the most common comorbidities found in the overall group. The incidence of VTE was 32.55 [95% CI 28.4, 37.3] per 100,000 admission per year [0.032%]. The annual incidence was least in 2015 (17.8 per 100,000 admissions) and highest in 2018 (44.4 per 100,000 admissions). Eighty-six subjects had DVT, and 109 had PE, whereas 14 had both. And, 67.5% of the patients developed VTE during admission while, 32.5% developed within 1 month of discharge. Moreover, 22.9% of the patients with PE developed pulmonary embolism after discharge from the hospital. VTE assessment was performed on 64.7% of the patients, and 69.7% received VTE prophylaxis in accordance with guidelines. Conclusion: Although the occurrence of VTE among hospitalized patients in Qatar is low, healthcare providers need additional education and knowledge of VTE assessment and prophylaxis to follow guidelines for all patients at the time of admission. Furthermore, risk assessment for VTE should be done for all patients at the time of discharge to decide on post-discharge prophylaxis so that incidence of VTE after discharge can be minimized. Future studies should focus on patients who developed VTE after discharge from the hospital as well as on various risk factors.

Al Wakra type II myocardial infarction-a case report in our emergency department.

In our emergency department (ED), we found one interesting case that had dramatic deterioration. The patient initially presented with a fever that deteriorated to sepsis, then a septic shock and chest discomfort and finally resulting in an intensive care unit (ICU) admission. He waited more than 6 hours in the waiting area, for a bed in an observation room. Phlebotomy and supportive treatment were provided in the waiting area but maybe it needed more rapid treatment to avoid the serious complications. The case rapidly deteriorated as type II myocardial infarction (MI). Al WAKRA TYPE II MI, is a case report for type II MI developed in ED as complication of prolonged waiting time in overcrowded ED, its simple fever case getting deterioration to sepsis then type II MI after prolonged waiting time in the waiting area of ED to get a bed in the observation room. We aim to report a case of type II MI in ED as rare case developed in overcrowded ED, to put highlight about overcrowded ED and how to manage it to avoid this complication again, also to be aware about pre sepsis presentation in ED with full consideration about sepsis complication and management. It could be considered as a case study for the Quality in overcrowded ED.