title: Thromboprophylaxis use and concordance with guidelines among medical and surgical patients in Morocco.
abstract: BACKGROUND
  No data are available on thromboprophylaxis use in Morocco. Our aim was to characterize patients at risk of venous thromboembolism and assess the rate of appropriate thromboprophylaxis.
  
  
  METHODS
  This was a national, observational, multicentre survey of venous thromboembolism risk and thromboprophylaxis use in hospitalized patients. Data were collected on a predefined date in three university hospitals in Morocco using a standardized pre-printed form. Thromboembolic risk was assessed according to the American College of Chest Physicians (ACCP) 2008 guidelines. Patients were classified as "thromboprophylaxis indicated" or "thromboprophylaxis not indicated".
  
  
  RESULTS
  784 patients were analysed: 307 (39.2%) medical and 477 (60.8%) surgical. 421 (53.7%) were female. Medical patients were older than surgical patients (57.6 ± 11.5 vs. 46.2 ± 16.9 years, p<0.0001) and were more likely to have risk factors for thromboembolism (50.5% vs. 45.7% of patients, p=NS). 57% of patients without contraindications or bleeding risk were at risk of thromboembolism according to ACCP guidelines and thromboprophylaxis was prescribed to 42.8% of these patients. In contrast, 7.4% of patients with no thromboembolic risk also received thromboprophylaxis (proportion agreement: 61.0%; Kappa=0.296). Over half (54.5%) of medical patients at risk of thromboembolism did not receive thromboprophylaxis whereas 6.3% of those with no risk did receive it (proportion agreement: 76.4%; Kappa=0.433). These figures were 57.9% and 9.2%, respectively, for surgical patients (proportion agreement: 52.7%; Kappa=0.191). Thromboprophylaxis was given to 19.2% of patients with contraindications or a bleeding risk.
  
  
  CONCLUSIONS
  Educational initiatives are imperative to inform doctors about appropriate thromboprophylaxis.
authors: Internal Medicine Department, Ibn Sina University Hospital, Rabat, Morocco. Electronic address: z.tazimezalek@gmail.com.
authors: Tazi Mezalek
authors: TM
authors: Zoubida
authors: Anaesthesiology and Critical Care Department, Ibn Sina University Hospital, Rabat, Morocco.
authors: Abderahim
authors: A
authors: Azzouzi
authors: Internal Medicine Department, Hassan II University Hospital, Fez, Morocco.
authors: Wafaa
authors: W
authors: Bono
authors: Intensive Care Unit - Maternity, Souissi Maternity, Rabat, Morocco.
authors: Rajae
authors: R
authors: Tachinante
authors: Emergency Surgical Intensive Care Unit, Ibn Sina University Hospital, Rabat, Morocco.
authors: Mamoun
authors: M
authors: Faroudy
authors: Internal Medicine Department, Ibn Tofail University Hospital, Marrakech, Morocco.
authors: Lamiaa
authors: L
authors: Essaadouni
authors: Epidemiology and Clinical Research Department, Hassan II University Hospital, Fez, Morocco.
authors: Chakib
authors: C
authors: Nejjari
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D009018:Morocco; D015995:Prevalence; D011655:Pulmonary Embolism / Q000188:drug therapy*; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000379:methods; D054556:Venous Thromboembolism / Q000188:drug therapy*
chemical_list: D000925:Anticoagulants
keywords: Contraindications; Hospitalized patients; Observational study; Risk factors; Thromboprophylaxis; Venous thromboembolism