Evaluation of pharmacological prophylaxis for deep venous thrombosis in hospitalized patients with risk factors at the university teaching hospitals, Lusaka, Zambia
Keywords:Pharmacological prophylaxis, Risk factors, Thromboembolism, Caprini score, Deep vein thrombosis
Background: Deep venous thrombosis is a common clinical problem accounting for high rates of morbidity and mortality. The existence of risk factors, which include trauma, venous stasis, and hypercoagulability, is linked to the occurrence of the condition. Objective of current study was to evaluate DVT risk factors and prophylaxis pattern of use for patients who were admitted at the University Teaching Hospitals in Lusaka, Zambia.
Methods: A cross-sectional study was conducted using medical files for patients who were hospitalized at the University Teaching Hospitals in Lusaka, Zambia from May 2020 to June 2021. Two hundred and ninety-six patient files were reviewed, and the Caprini risk assessment model was used to stratify patients into DVT risk categories. Multilinear regression analysis was used to identify factors associated with DVT prophylaxis.
Results: Of the 296 patient files that were sampled from ICU, medical, and surgical wards, 198 (66.9%) (>2 caprini score) were eligible for DVT prophylaxis, but only 77 (38.9%) of these eligible patients received prophylaxis. The number of eligible patients for DVT prophylaxis per department was as follows; ICU 50 (100%), Medical 71 (57.7%) and Surgery 77 (62.6%) wards. However, DVT prophylaxis was given to 21 (42%), 33 (46.5%), and 23 (29.9%) patients from the ICU, medical, and surgery, respectively. Enoxaparin was the most commonly used anticoagulant for Venous thromboembolism (VTE) prophylaxis with a mean dose of 60mg (SD±5). Across all departments, the most common predisposing risk factors for DVT were bed confinement for >72 hours (167, 56.4%) and age of 41-60 years (118, 39.8%). In the adjusted model, swollen legs (AOR: 3.6, CI: 1.97, 6.57) and history of VTE (AOR: 21.3, CI: 9.87, 46.08) were significantly associated with a higher likelihood of DVT prophylaxis.
Conclusions: Pharmacologic thromboprophylaxis is underutilized in patients in ICU, medical and surgical wards at the university teaching hospitals in Lusaka, Zambia. This study underscores the importance of implementing a DVT risk assessment technique for patients in ICU, medical and surgical wards and administering prophylaxis unless contraindicated.
Stone J, Hangge P, Albadawi H, Wallace A, Shamoun F, Knuttien MG, et al. Deep vein thrombosis: pathogenesis, diagnosis, and medical management. Cardiovasc Diagn Ther. 2017;7(Suppl 3):S276.
Bâ SA, Badiane SB, Diop SN, Diouf FS, Fall D, Mamadou MK, et al. A cross-sectional evaluation of venous thromboembolism risk and use of venous thromboembolism prophylaxis in hospitalized patients in Senegal. Arch Cardiovasc Dis. 2011;104(10):493-501.
Kesieme E, Kesieme C, Jebbin N, Irekpita E, Dongo A. Deep vein thrombosis: a clinical review. J Blood Med. 2011;2:59.
Najafzadeh M, Kim SC, Patterson C, Schneeweiss S, Katz JN, Brick GW, et al.Patients’ perception about risks and benefits of antithrombotic treatment for the prevention of venous thromboembolism (VTE) after orthopedic surgery: a qualitative study. BMC Musculoskelet Disord. 2015;16(1):1-8.
Apenteng PN, Fitzmaurice D, Litchfield I, Harrison S, Heneghan C, Ward A, et al .Patients' perceptions and experiences of the prevention of hospital-acquired thrombosis: a qualitative study. BMJ. 2016;6(12):e013839.
O'Donnell M, Weitz JI. Thromboprophylaxis in surgical patients. Canad J Surg. 2003;46(2):129.
Caprini JA. Risk assessment as a guide for the prevention of the many faces of venous thromboembolism. Am J Surg. 2010;199(1):S3-10.
Shah SS, Abdi A, Özcem B, Basgut B. The rational use of thromboprophylaxis therapy in hospitalized patients and the perspectives of health care providers in Northern Cyprus. PloSone. 2020;15(7):e0235495.
Barbar S, Noventa F, Rossetto V, Ferrari A, Brandolin B, Perlati M, et al. A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: the Padua Prediction Score. J Thromb Haemost. 2010;8(11):2450-7.
Mahlab-Guri K, Otman MS, Replianski N, Rosenberg-Bezalel S, Rabinovich I, Sthoeger Z. Venous thromboembolism prophylaxis in patients hospitalized in medical wards: a real life experience. Medicine. 2020;99(7):23-9.
Spencer FA, Emery C, Joffe SW, Pacifico L, Lessard D, Reed G, et al. Incidence rates, clinical profile, and outcomes of patients with venous thromboembolism. The Worcester VTE study. J Thromb. 2009;28(4):401-9.
Cohen AT, Tapson VF, Bergmann JF, Goldhaber SZ, 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. 2008;371(9610):387-94.
Lloyd N, Douketis J, Moinuddin I, Lim W, Crowther M. Anticoagulant prophylaxis to prevent asymptomatic deep vein thrombosis in hospitalized medical patients: a systematic review and metaanalysis. J Thromb Haemost. 2008;6(3):405-414.
Alikhan R, Peters F, Wilmott R, Cohen A. Fatal pulmonary embolism in hospitalised patients: a necropsy review. J Clin Pathol. 2004;57(12):1254-7.
Cohen AT, Edmondson RA, Phillips MJ, Ward VP, Kakkar VV. The changing pattern of venous thromboembolic disease. Pathophysiol Haemost Thromb. 1996;26(2):65-71.
Rocha AT, de Vasconcellos ÂG, da Luz Neto ER, Araújo D, Alves ES, Lopes AA. Risk of venous thromboembolism and efficacy of thromboprophylaxis in hospitalized obese medical patients and in obese patients undergoing bariatric surgery. Obes Surg. 2006;16(12):1645-55.
Wattanakit K, Cushman M. Chronic kidney disease and venous thromboembolism: epidemiology and mechanisms. Curr Opinion Pulm Med. 2009;15(5):408.
Spyropoulos AC, Anderson FA, FitzGerald G, Decousus H, Pini M, Chong BH, et al . Predictive and associative models to identify hospitalized medical patients at risk for VTE. Chest. 2011;140(3):706-14.
Badawi O, Lilly C, Liu X, Zuckerman I, Franey C. Thrombosis prophylaxis and mortality risk among critically Ill Adults. Crit Care Med. 2013;41(12):A167.
Laryea J, Champagne B. Venous thromboembolism prophylaxis. Clin Colon Rectal Surg. 2013;26(03):153-9.
Le P, Martinez K, Pappas M, Rothberg M. A decision model to estimate a risk threshold for venous thromboembolism prophylaxis in hospitalized medical patients. J Thromb Haemost. 2017;15(6):1132-41.
MacDougall K, Spyropoulos AC. Prevention of Venous thromboembolism in acutely Ill medical patients: a new era. Semin Respir Crit Care Med. 2021;42(2):308-15.
Guyatt GH, Akl EA, Crowther M, Gutterman DD, Schuünemann HJ. Executive summary: antithrombotic therapy and prevention of thrombosis: American college of chest physicians evidence-based clinical practice guidelines. Chest. 2012;141(2):7S-47S.
Rocher W, Page T, Rocher M, Nel D. Venous thromboembolism risk and prophylaxis prescription in surgical patients at a tertiary hospital in Eastern cape province, South Africa. South African Med J. 2019;109(3):178-81.
Rehmani RS, Memon JI, Alaithan A, Ghabashi A, Shahid K, Latif S, et al . enous thromboembolism. Saudi Med J. 2011;32(11):1149-54.
Wessels P, Riback WJ. DVT prophylaxis in relation to patient risk profiling–the tune-in study. South African Med J. 2012;102(2):23-9.
Bergmann JF, Cohen AT, Tapson VF, Goldhaber SZ, Kakkar AK, Deslandes B, et al .Venous thromboembolism risk and prophylaxis in hospitalised medically ill patients. Thromb Haemost. 2010;103(04):736-48.
Tadesse TA, Kedir HM, Fentie AM, Abiye AA. Venous thromboembolism risk and thromboprophylaxis assessment in surgical patients based on caprini risk assessment model. Risk Manag Healthcare. 2020;13:2545.
Wehmeyer A, Coetzee R, McCartney J. Venous thromboembolism risk assessment and prophylaxis in hospitalised medical patients in the Cape Town metropole, South Africa. South African Med J. 2020;112(2):117-23.
Khalili H, Dashti-Khavidaki S, Talasaz AH, Mahmoudi L, Eslami K, Tabeefar H. Is deep vein thrombosis prophylaxis appropriate in the medical wards? A clinical pharmacists’ intervention study. Pharm World Sci. 2010;32(5):594-600.
Vallano A, Arnau JM, Miralda GP, Pérez-Bartolí J. Use of venous thromboprophylaxis and adherence to guideline recommendations: a cross-sectional study. Thromb J. 2004;2(1):1-7.
Van der Merwe M, Julyan M, Du Plessis JM. Is guideline-driven prophylaxis for venous thromboembolism common practice in the South African private hospital setting? South African Family Pract. 2020;62(1):23-9.
Kahn SR, Panju A, Geerts W, Pineo GF, Desjardins L, Turpie AG, 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.