title: Venous thromboembolism risk assessment, prophylaxis practices and interventions for its improvement (AVAIL-ME Extension Project, Iran).
abstract: BACKGROUND
  Venous thromboembolism (VTE) is a major health issue worldwide. Data about VTE prophylaxis practices in developing countries are scarce.
  
  
  OBJECTIVE
  The primary objectives of this survey were to define the VTE risk factors in hospitalized patients, to determine the rates of VTE prophylaxis administration and guideline compliance and to assess the effects of an educational program on VTE prophylaxis practices in Iran.
  
  
  METHODS
  Data on 1219 patients from twenty hospitals in Iran were extracted from the AVAIL-ME Extension project main databank. VTE risks were categorized according to the Caprini Risk Assessment Model. Logistic regression analysis was carried out to assess factors influencing VTE prophylaxis. We also examined the impact of an educational program which consisted of awareness, risk assessment, internal protocol implementation and re-assessment, on VTE prophylaxis practices.
  
  
  RESULTS
  Of 1219 patients, 789 (65%) and 430 (35%) were surgical and medical, respectively. VTE risks, categorized in low, moderate, high and very high were detected in 14%, 17%, 26% and 43% of patients respectively with a total of 1042(85%) patients being at risk for VTE. Of 882 (85%) eligible patients for VTE prophylaxis, 737 (83.5%) received any drug prophylaxis of whom 265 (62%) were medical and 472 (60%) were surgical. ACCP guidelines compliance was 60% and 33% in surgical and medical patients respectively. Any VTE prevention, drug prophylaxis, mechanical prophylaxis and guideline adherence were, 48% vs. 64%, 45% vs. 60%, 6% vs. 9% and 34% vs. 45% respectively (p<00.1) before and after implementation of the VTE educational program.
  
  
  CONCLUSIONS
  Despite an overall improvement in VTE prevention, areas such as inappropriate use of VTE prophylaxis in a large number of patients, significant under-use of mechanical devices and guideline adherence require closer attention. VTE awareness education is beneficial in improving VTE prophylaxis in Iran.
authors: Internal Medicine, Pulmonary and Critical Care Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Electronic address: majimokh@gmail.com.
authors: Majid
authors: M
authors: Mokhtari
authors: Department of Hematology, Shahid Beheshti University of Medical Sciences, Modarres Hospital, Tehran, Iran.
authors: Hamid
authors: H
authors: Attarian
authors: Department of Orthopedic Surgery, Rasool-E-Akram Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors: Masoud
authors: M
authors: Norouzi
authors: Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors: Mehran
authors: M
authors: Kouchek
authors: Department of Cardiology, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Masih Daneshvari Hosp., Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors: Babak Sharif
authors: BS
authors: Kashani
authors: Tehran Medical University, Tehran, Iran.
authors: Fereidoun
authors: F
authors: Sirati
authors: Sanofi Medical Department, Tehran, Iran.
authors: Behin
authors: B
authors: Pourmirza
authors: Sanofi Medical Department, Tehran, Iran.
authors: Elham
authors: E
authors: Mir
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003625:Data Collection; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007492:Iran; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000209:etiology* / Q000517:prevention & control*; D055815:Young Adult
keywords: Education; Guidelines; Risk assessment; Thromboembolism