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Ramalli EL, Dalio MB, Ribeiro MS, Joviliano EE. Adequacy of venous thromboembolism risk stratification and prophylaxis in a tertiary university hospital. J Vasc Bras 2023; 22:e20230007. [PMID: 37576722 PMCID: PMC10421582 DOI: 10.1590/1677-5449.202300071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/23/2023] [Indexed: 08/15/2023] Open
Abstract
Background Venous thromboembolism is the third most common cardiovascular disease and the main cause of preventable death in hospitalized patients. Prophylaxis is still underused, despite well-established guidelines in the literature. Studies show a worldwide prophylaxis adequacy rate close to 50%. Objectives To assess the adequacy of risk stratification and prophylactic measures for venous thromboembolism in a tertiary university hospital. Methods A cross-sectional observational study was carried out, collecting data from medical records. Adult patients hospitalized by different specialties were enrolled and divided into surgical and clinical groups. The risk stratification of venous thromboembolism performed by the attending physicians was compared with stratification based on recent guidelines performed by the research physicians. Prophylaxis measures prescribed by the attending physicians were compared with guideline recommendations, thus obtaining the prophylaxis adequacy rate. Results 400 patients were analyzed, 169 (42.3%) surgical and 231 (57.7%) clinical. The overall stratification adequacy rate was 50.8%. Adequacy rates were 39.1% and 59.3% in the surgical and clinical groups respectively (P < 0.0001). The overall prophylaxis adequacy rate was 71.5%, with 78.1% in the surgical group and 66.7% in the clinical group (P=0.0137). Conclusions Risk stratification adequacy is low, demonstrating a low awareness among prescribing physicians of the need for adequate stratification for prescription of prophylaxis. However, the prophylaxis prescription adequacy rates are higher than those in global data.
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Affiliation(s)
- Edvaldo Luiz Ramalli
- Universidade de São Paulo – USP, Faculdade de Medicina de Ribeirão Preto, Departamento de Cirurgia e Anatomia, Hospital das Clínicas, Divisão de Cirurgia Vascular e Endovascular, Ribeirão Preto, SP, Brasil.
| | - Marcelo Bellini Dalio
- Universidade de São Paulo – USP, Faculdade de Medicina de Ribeirão Preto, Departamento de Cirurgia e Anatomia, Hospital das Clínicas, Divisão de Cirurgia Vascular e Endovascular, Ribeirão Preto, SP, Brasil.
| | - Maurício Serra Ribeiro
- Universidade de São Paulo – USP, Faculdade de Medicina de Ribeirão Preto, Departamento de Cirurgia e Anatomia, Hospital das Clínicas, Divisão de Cirurgia Vascular e Endovascular, Ribeirão Preto, SP, Brasil.
| | - Edwaldo Edner Joviliano
- Universidade de São Paulo – USP, Faculdade de Medicina de Ribeirão Preto, Departamento de Cirurgia e Anatomia, Hospital das Clínicas, Divisão de Cirurgia Vascular e Endovascular, Ribeirão Preto, SP, Brasil.
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Curtarelli A, Correia E Silva LP, de Camargo PAB, Pimenta REF, Jaldin RG, Bertanha M, Sobreira ML, Yoshida WB. Venous thromboembolism, can we do better? Profile of venous thromboembolism risk and prophylaxis in a University Hospital in the State of São Paulo. J Vasc Bras 2019; 18:e20180040. [PMID: 31236100 PMCID: PMC6579528 DOI: 10.1590/1677-5449.004018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 10/16/2018] [Indexed: 11/21/2022] Open
Abstract
Background Venous thromboembolism (VTE) is a silent and potentially lethal disease that affects a considerable proportion of hospitalized patients. It has high morbidity and mortality and is responsible for a heavy financial burden on healthcare systems. However, VTE can be prevented using prophylaxis measures that have been established in the literature. Nonetheless, in the real world, mean rates of appropriately administered VTE prophylaxis are lower than 50%. Objectives To define the epidemiological profile of patients with VTE in a University Hospital and the rate of appropriately administered VTE prophylaxis at that service and to identify measures to improve the rate. Methods A cross-sectional, observational study was conducted with data collected from the medical records of patients who met the inclusion criteria. The rates of correct VTE prophylaxis prescribed to clinical and surgical patients were compared, assessed according to guidelines published by the Brazilian Society of Angiology and Vascular Surgery (SBACV), based on VTE risk classification. Results The overall rate of correctly-prescribed VTE prophylaxis was 42.1%, while 57.9% of patients were not managed correctly in this respect. Clinical patients had a 52.9% rate of appropriate prophylaxis, while the equivalent rate for surgical patients was 37.5%. Conclusions Rates of correctly-prescribed VTE prophylaxis are still lower than they should be. Ongoing education, measures to encourage bedside risk stratification, and improvements to the electronic prescription system could increase appropriate VTE prophylaxis rates.
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Affiliation(s)
- Arthur Curtarelli
- Universidade Estadual "Júlio de Mesquita Filho" - UNESP, Faculdade de Medicina de Botucatu (FMB), Hospital das Clínicas (HC), Botucatu, SP, Brasil
| | - Luiz Paulo Correia E Silva
- Universidade Estadual "Júlio de Mesquita Filho" - UNESP, Faculdade de Medicina de Botucatu (FMB), Hospital das Clínicas (HC), Botucatu, SP, Brasil
| | - Paula Angeleli Bueno de Camargo
- Universidade Estadual "Júlio de Mesquita Filho" - UNESP, Faculdade de Medicina de Botucatu (FMB), Hospital das Clínicas (HC), Botucatu, SP, Brasil
| | - Rafael Elias Farres Pimenta
- Universidade Estadual "Júlio de Mesquita Filho" - UNESP, Faculdade de Medicina de Botucatu (FMB), Hospital das Clínicas (HC), Botucatu, SP, Brasil
| | - Rodrigo Gibin Jaldin
- Universidade Estadual "Júlio de Mesquita Filho" - UNESP, Faculdade de Medicina de Botucatu (FMB), Hospital das Clínicas (HC), Botucatu, SP, Brasil
| | - Matheus Bertanha
- Universidade Estadual "Júlio de Mesquita Filho" - UNESP, Faculdade de Medicina de Botucatu (FMB), Hospital das Clínicas (HC), Botucatu, SP, Brasil
| | - Marcone Lima Sobreira
- Universidade Estadual "Júlio de Mesquita Filho" - UNESP, Faculdade de Medicina de Botucatu (FMB), Hospital das Clínicas (HC), Botucatu, SP, Brasil
| | - Winston Bonetti Yoshida
- Universidade Estadual "Júlio de Mesquita Filho" - UNESP, Faculdade de Medicina de Botucatu (FMB), Hospital das Clínicas (HC), Botucatu, SP, Brasil
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Zamboni Carini Couto T, Arena Moreira Domingues T, Coelho Ramalho Vasconcelos Morais S, de Lima Lopes J, Takao Lopes C. Risk of venous thromboembolism and implementation of preventive measures. ENFERMERIA CLINICA 2019; 30:333-339. [PMID: 30712999 DOI: 10.1016/j.enfcli.2018.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 12/14/2018] [Accepted: 12/23/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify the frequency of risk factors for venous thromboembolism in hospitalized medical patients and the use preventive measures by healthcare professionals. METHOD A descriptive, cross-sectional, retrospective study including medical charts of 369 adult patients hospitalized in the Medical sector of a university hospital in São Paulo, Brazil, for at least 48h from 2015 to 2017. Sociodemographic data, clinical risk factors for venous thromboembolism, contraindication and implementation of chemical prophylaxis, and the occurrence of the disease were investigated. The use of preventive measures was calculated by following the guidelines of the Brazilian Society of Clinical Medicine and the risk of venous thromboembolism according to the Padua Prediction Score (high risk ≥ 4 and low risk < 4). RESULTS The prevalence of venous thromboembolism was 7.3% (n = 27). All patients had at least one risk factor for venous thromboembolism, the most prevalent being reduced mobility (74.2%), active cancer (70.7%), infection (27.1%), recent surgery (21.6%) and age ≥70 years (20.0%). Chemical prophylaxis was implemented in 70.3% of high-risk patients without contraindication and mechanical prophylaxis was applied in only one of the cases with an indication. CONCLUSIONS All patients had at least one risk factor for venous thromboembolism. However, there was a low rate of implementation of preventive measures by health care professionals. Therefore, there is a need for multiple interventions, including admission and permanent education of nurses regarding risk and prevention, warning systems and outcomes audit.
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Affiliation(s)
| | | | | | - Juliana de Lima Lopes
- Escola Paulista de Enfermagem, Universidade Federal de São Paulo (EPE-UNIFESP), São Paulo, Brasil
| | - Camila Takao Lopes
- Escola Paulista de Enfermagem, Universidade Federal de São Paulo (EPE-UNIFESP), São Paulo, Brasil.
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Farhat FCLG, Gregório HCT, de Carvalho RDP. Evaluation of deep vein thrombosis prophylaxis in a general hospital. J Vasc Bras 2019; 17:184-192. [PMID: 30643503 PMCID: PMC6326129 DOI: 10.1590/1677-5449.007017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background Venous thromboembolism (VTE) is a cause for growing concern in hospitals, has great impact on morbidity and mortality in clinical and surgical patients, and is the leading cause of preventable hospital deaths. Although there are risk assessment models for hospital inpatients, prophylaxis is still underused or is administered incorrectly. Objectives To assess the risk profile for VTE in recently hospitalized clinical and surgical patients and evaluate the thromboprophylactic measures implemented in the first 24 hours of hospitalization. Methods Cross-sectional study conducted in a large general hospital in the state of São Paulo, Brazil, between March and July 2015. Padua and Caprini scores were used for risk stratification of clinical and surgical patients, respectively, while thromboprophylactic measures were analyzed for compliance with the recommendations contained in the 8th and 9th Consensus of the American College of Chest Physicians. Results A total of 592 patients (62% clinical and 38% surgical) were assessed. Risk stratification revealed a need for chemoprophylaxis in 42% of clinical patients and 81% of surgical patients (51% high risk and 30% moderate risk). However, 54% of high-risk clinical patients, 85% of high-risk surgical patients, and 4% of moderate-risk surgical patients, who were free from contraindications, were actually given the correct prophylaxis in the first 24 hours of hospitalization. Conclusions There is a need to improve patient safety in relation to VTE in the first hours of hospitalization, since there is underutilization of chemoprophylaxis, especially in high-risk clinical patients and moderate-risk surgical patients.
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Cortada APDS, Silva TGD, Silva ACD, Golmia RP, Guerra RL, Takemoto MLS, Monteiro RDC, Scheinberg MA. Comparison of thromboprophylaxis patterns in arthroplasty in public and private hospitals. EINSTEIN-SAO PAULO 2015; 13:410-6. [PMID: 26313439 PMCID: PMC4943787 DOI: 10.1590/s1679-45082015gs3057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 08/29/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To compare therapy for prophylaxis of venous thromboembolism and costs related to hospitalization of patients undergoing total knee and hip replacement within the context of the Brazilian health system. METHODS A retrospective study of patients undergoing arthroplasty in 2010 in a public hospital and two private hospitals in the state of São Paulo, conducted by means of medical record review. Costs were estimated based on the use of health care resources during hospitalization. A descriptive analysis was performed using frequency and mean (standard deviation) according to the type of care delivered (by public or private organization). RESULTS A total of 215 patients were evaluated, and 56.3% were submitted to knee surgery and 43.7%, to hip replacement. Approximately 88% and 98% of patients from public and private health services, respectively, received some form of venous thromboembolism prophylaxis, and enoxaparin was the drug most widely used in both systems. The total cost of prophylaxis was R$ 1,873.01 (R$ 26.38 per patient) in the public service and R$ 21,559.73 (R$ 163.33 per patient) in the private service. For the individuals who presented with thromboembolism, the average cost of hospitalization was R$ 6,210.80 and R$ 43,792.59 per patient in public and private health services, respectively. CONCLUSION Thromboembolism prophylaxis in patients undergoing arthroplasty is most commonly used in the private health services than public organizations, despite its high costs in both services. The cost per patient with thrombosis during hospitalization was higher than the total cost of prophylaxis, suggesting that prevention is associated to better cost-benefit ratio.
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Kerbauy MN, Moraes FYD, Kerbauy LN, Conterno LDO, El-Fakhouri S. Tromboprofilaxia venosa em pacientes clínicos: análise de sua aplicação. Rev Assoc Med Bras (1992) 2013; 59:258-64. [DOI: 10.1016/j.ramb.2012.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 10/09/2012] [Accepted: 11/04/2012] [Indexed: 10/26/2022] Open
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