[Impact of a program for venous thromboembolism prophylaxis in hospitalized patients in four hospitals in Salvador].
There is a discrepancy between guideline recommendations and practice of venous thromboembolism (VTE) prophylaxis in hospitals worldwide.


OBJECTIVE
To implement a program using a risk-assessment tool (RAT) for VTE and educational lectures based on the Brazilian Guidelines for VTE Prophylaxis for Medical Patients and to evaluate the impact of these tools on adequacy of VTE prophylaxis in 4 hospitals in Salvador, Bahia.


METHODS
We performed two cross-sectional surveys before and after the implementation of the program to compare the proportion of patients at-risk of VTE and the changes in the adequacy of VTE prophylaxis.


RESULTS
We compared the data of 219 medical patients before with 292 patients after the program. The rates of patients with at least one risk factor for VTE and with contraindications (CI) for heparins were similar: 95% vs. 98% (p=0.13), and 42% vs. 34% (p=0.08), respectively. In both studies, 75% vs. 82% (p=0.06) were candidates for prophylaxis, and 44% vs. 55% (p =0.02) were candidates for prophylaxis and had no CI for heparin. After the program there was an increase in the use of mechanical prophylaxis 0.9% vs. 4.5% (p=0.03) and a decrease in pharmacological prophylaxis, 55.3% vs. 47.9% (p=0.04). However, there was a significant increase of use of the recommended doses of heparins, 53% vs. 75 (p<0.001).


CONCLUSIONS
There is underutilization of VTE prophylaxis in Brazilian hospitals. Strategies based on passive distribution of RAT and educational lectures were not sufficient to improve the practice of prophylaxis, but improved the adequacy of VTE prophylaxis in hospitalized patients.
Rocha
Ana Thereza C
AT
Hospital Universitário Professor Edgard Santos, Salvador, BA.
Paiva
Edison Ferreira de
EF
Araújo
Danilo Miranda de
DM
Cardoso
Dulceane Natyara
DN
Pereira
Aline Cristina da Hora
AC
Lopes
Antônio Alberto
AA
Darzé
Eduardo S
ES
D000328:Adult; D000465:Algorithms; D000925:Anticoagulants / Q000627:therapeutic use*; D001938:Brazil; D003430:Cross-Sectional Studies; D005260:Female; D017408:Guidelines as Topic; D006282:Health Personnel / Q000193:education*; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D007318:Inservice Training; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000517:prevention & control*
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight