Risk of venous thromboembolic disease and adequacy of prophylaxis in hospitalized patients in Argentina: a multicentric
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ORIGINAL CLINICAL INVESTIGATION
Open Access
Risk of venous thromboembolic disease and adequacy of prophylaxis in hospitalized patients in Argentina: a multicentric cross-sectional study Fernando Vazquez1*, Ricardo Watman2, Aldo Tabares3, Carina Gumpel4, Enrique Baldessari5, Alicia B Vilaseca6, Federico J Capparelli7 and Esteban Lifschitz8
Abstract Background: Venous thromboembolic disease (VTE) is associated with high morbi-mortality. Adherence rate to the recommendations of antithrombotic prophylaxis guidelines (ATPG) is suboptimal. The aim of this study was to describe the adequacy of antithrombotic prophylaxis (ATP) in hospitalized patients as the initial stage of a program designed to improve physician adherence to –ATP recommendations in Argentina. Methods: This study was a multicenter, cross-sectional study that included 28 Institutions throughout 5 provinces in Argentina. Results: 1315 patients were included, 729 (55.4%) were hospitalized for medical (clinical) reasons, and 586 (44.6%) for surgical reasons. Adequate ATP was provided to 66.9% of the patients and was more frequent in surgical (71%) compared to clinical (63.6%) subjects (p < 0.001). Inadequate ATP resulted from underuse in 76.6% of the patients. Among clinical, 203 (16%) had increased bleeding risk and mechanical ATP was used infrequently. Conclusions: The adequacy of ATP was better in low VTE risk clinical and surgical patients and high VTE risk in orthopedic patients. There was worse adequacy in high risk patients (with active neoplasm) and in those with pharmacological ATP contraindications, in which the use of mechanical methods was scarce. The adequacy of ATP was greater at institutions with < 150 beds compared with larger institutions. This is the first multicentric study reporting ATP in Argentina. Understanding local characteristics of medical performance within our territory is the first step in order to develop measures for improving ATP in our environment. Keywords: Thrombosis, Thromboprophylaxis, Venous thromboembolic disease, Adequacy, Pulmonary embolism, Deep vein thrombosis
Background Venous thromboembolic disease (VTE) is associated with high morbidity and mortality. Approximately 2 million cases of deep venous thrombosis (DVT) and 200,000 deaths from pulmonary embolism (PE) are reported annually in the United States [1]. These numbers exceed those from breast cancer and AIDS deaths combined [2-4]. Additionally, VTE affect quality of life during both acute and chronic phase [5,6], due to the disease itself and the bleeding risk as a complication of anticoagulation. * Correspondence: [email protected] 1 Internal Medicine Department, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, (C1181ACH), Buenos Aires, Argentina Full list of author information is available at the end of the article
Despite its health impact [1,7] and the availability of evidence-based antithrombotic guidelines (ATPG) on prophylaxis [8-10], the adherence rate to such recommendations has been reported in several studies as bein
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