Evaluation of the frequency of venous thromboembolism prophylaxis in a selected population of patients hospitalized in nonsurgical wards. Results of the all-Poland EPID Registry.
BACKGROUND
The results of the Prophylaxis in Medical Patients with Enoxoparin (MEDENOX) trial demonstrated the benefit of thromboprophylaxis in patients hospitalized because of acute heart failure, respiratory failure and rheumatic disease. Analysis of clinical practice shows that thromboprophylaxis is rarely used in these patients.


OBJECTIVE
To assess thromboprophylaxis use in a selected population of patients hospitalized in internal departments in Poland.


METHODS
Between the years 2002 and 2006, 14,707 hospitalized patients were included into the EPID Registry. The study population, selected for the purpose of this analysis, involved 5246 patients (mean age 71, 95% CI: 70.6 -71.4 years), reported by 60 internal wards, who met the entry criteria of the MEDENOX study. Patients receiving long-term antithrombotic treatment and patients with indications for initiating antithrombotic treatment were not enrolled.


RESULTS
Thromboprophylaxis was administered in 63% of patients. The average duration of thromboprophylaxis was 8.1 days (95% CI: 7.8-8.4). In the group of patients admitted to the intensive care unit thromoprophylaxis was administered in 81% of cases compared with 58% in nonsurgical departments (p < 0.0001). Low-molecular-weight heparins were used in 93% of patients receiving prophylaxis. The risk of hemorrhage (9.5%) and lack of indications for thromboprophylaxis (27%) according to the physicians were the main reasons for not using prophylaxis. The frequency of thromboprophylaxis use varied from 35% to 89% between different regions of Poland. Hemorrhagic complications were reported in 0.8% of patients receiving prophylaxis.


CONCLUSIONS
Administration of thromboprophylaxis in the MEDENOX-like population is of great importance from an epidemiological point of view because this patient group accounts for 31% of in-patients. Thromboprophylaxis is underused with large differences between regions, which should be improved by an adequate educational program for physicians from internal wards.
Kurzyna
Marcin
M
Department of Chest Diseases, Institute of Tuberculosis and Lung Diseases, Warszawa, Poland. m.kurzyna@igichp.edu.pl
D000368:Aged; D004334:Drug Administration Schedule; D017723:Drug Utilization Review / Q000706:statistics & numerical data*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011044:Poland / Q000453:epidemiology; D012042:Registries; D054556:Venous Thromboembolism / Q000453:epidemiology / Q000517:prevention & control*
D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight