Venous thromboembolism risk and prophylaxis in hospitalised medically ill patients. The ENDORSE Global Survey.
Limited data are available regarding the risk for venous thromboembolism (VTE) and VTE prophylaxis use in hospitalised medically ill patients. We analysed data from the global ENDORSE survey to evaluate VTE risk and prophylaxis use in this population according to diagnosis, baseline characteristics, and country. Data on patient characteristics, VTE risk, and prophylaxis use were abstracted from hospital charts. VTE risk and prophylaxis use were evaluated according to the 2004 American College of Chest Physicians (ACCP) guidelines. Multivariable analysis was performed to identify factors associated with use of ACCP-recommended prophylaxis. Data were evaluated for 37,356 hospitalised medical patients across 32 countries. VTE risk varied according to medical diagnosis, from 31.2% of patients with gastrointestinal/hepatobiliary diseases to 100% of patients with acute heart failure, active non-infectious respiratory disease, or pulmonary infection (global rate, 41.5%). Among those at risk for VTE, ACCP-recommended prophylaxis was used in 24.4% haemorrhagic stroke patients and 40-45% of cardiopulmonary disease patients (global rate, 39.5%). Large differences in prophylaxis use were observed among countries. Markers of disease severity, including central venous catheters, mechanical ventilation, and admission to intensive care units, were strongly associated with use of ACCP-recommended prophylaxis. In conclusion, VTE risk varies according to medical diagnosis. Less than 40% of at-risk hospitalised medical patients receive ACCP-recommended prophylaxis. Prophylaxis use appears to be associated with disease severity rather than medical diagnosis. These data support the necessity to improve implementation of available guidelines for evaluating VTE risk and providing prophylaxis to hospitalised medical patients.
Hôpital Lariboisière, University Paris 7, Paris, France. jf.bergmann@lrb.aphp.fr
Jean-Francois
JF
Bergmann
Alexander T
AT
Cohen
Victor F
VF
Tapson
Samuel Z
SZ
Goldhaber
Ajay K
AK
Kakkar
Bruno
B
Deslandes
Wei
W
Huang
Frederick A
FA
Anderson
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000075202:Contraindications; D003430:Cross-Sectional Studies; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D019983:Guideline Adherence; D019538:Health Care Surveys; D054625:Healthcare Disparities; D006470:Hemorrhage / Q000139:chemically induced; D006760:Hospitalization; D006801:Humans; D007297:Inpatients; D016015:Logistic Models; D008875:Middle Aged; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D012042:Registries; D012111:Residence Characteristics; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000209:etiology* / Q000517:prevention & control*
D005343:Fibrinolytic Agents