Profilaxia medicamentosa da trombose venosa profunda em pacientes submetidos à cirurgia do trauma em um hospital universitário

Adequacy of venous thromboembolism risk stratification and prophylaxis in a tertiary university hospital

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.

Risk of venous thromboembolism and implementation of preventive measures

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.

Sabemos prescrever profilaxia de tromboembolismo venoso nos pacientes internados?

Resumo Contexto Embora preconizada, a profilaxia de tromboembolismo venoso (TEV) deixa de ser realizada sistematicamente em pacientes internados. Objetivo Verificar se os pacientes hospitalizados recebem a prescrição correta da profilaxia de TEV do médico responsável por sua internação, conforme sua categoria de risco. Métodos Estudo transversal com análise de prontuários de pacientes internados no Hospital Santa Casa de Misericórdia de Curitiba, PR, entre 20 de março e 25 de maio de 2015. Excluíram-se os pacientes em uso de anticoagulantes ou com sangramento ativo. Analisou-se gênero, idade, tipo de cobertura de saúde, especialidade responsável pelo paciente e fatores de risco dos pacientes para classificá-los em alto, moderado ou baixo risco para TEV. Comparou-se o uso ou não da profilaxia entre as prescrições das especialidades clínicas e cirúrgicas, pacientes internados pelo Sistema Único de Saúde (SUS) e por convênios e de acordo com seu risco para TEV. Resultados Dos 78 pacientes avaliados, oito preencheram os critérios de exclusão. Dos 70 pacientes elegíveis (média etária 56,9 anos; 41 homens; 62 cobertos pelo SUS), 31 eram tratados por clínicos e 39 por cirurgiões. Apenas 46 (65,71%) pacientes receberam profilaxia para TEV. Dentre os pacientes clínicos, 29 (93,5%) receberam profilaxia, contra 17 (43,6%) do grupo cirúrgico (p < 0,001). Pacientes clínicos de moderado e alto risco receberam mais profilaxia que os cirúrgicos (p < 0,001 e p = 0,002). Não houve diferenças quanto à cobertura de saúde (SUS versus convênios médicos). Conclusões No Hospital Santa Casa de Misericórdia de Curitiba, pacientes cirúrgicos estão menos protegidos de eventos tromboembólicos em relação aos clínicos.

Prophylaxis of Venous Thromboembolism in Home Care: An Integrative Review

Venous thromboembolism (VTE) is a set of diseases that carries both the risk of sudden death and long-term morbidity. Several studies conducted in Brazilian hospitals have identified that most patients considered at high risk for VTE do not receive prophylactic anticoagulant prescription properly. Risk of VTE in patients under home care is unknown. The objective of this integrative review is to identify evidence regarding prophylaxis of VTE in home care. The databases PubMed/Medline, LILACS, and National Guideline Clearinghouse were searched for articles published between January 1985 and June 2015. Although there is an extensive literature and clear guidelines for the prophylaxis and treatment of VTE in the hospital environment, studies on the same subject in home care are scarce, sometimes small, and almost exclusively based on retrospective collection of chart data. Additional research on VTE prophylaxis in the home care setting is needed in order to develop evidence-based practice guidelines.