title: Underutilization of anticoagulant for venous thromboembolism prophylaxis in three hospitals in Jakarta.
abstract: OBJECTIVE
  to assess the current use of anticoagulants and implementation of International Guidelines in venous thromboembolism (VTE) prophylaxis in hospitalized patients with acute medical illnesses in Jakarta, Indonesia.
  
  
  METHODS
  a multicenter, prospective, disease registry, recruiting patients diagnosed as acutely ill medical diseases and other medical conditions at risk of VTE, with in-hospital immobilization for at least 3 days.
  
  
  RESULTS
  of 401 patients, 46.9% received anticoagulants which included unfractionated heparin (64.4%), fondaparinux (11.7%), enoxaparin (9.6%), warfarin (3.7%), and combination of anticoagulants (10.6%). VTE prophylaxis using physical and mechanical method was used in 81.3% of patients, either as a single modality or in combination with anticoagulants. During hospitalization, VTE were found in 3.2% patients; 10 patients (2.5%) had lower limb events and 3 patients (0.75%) had a suspected pulmonary embolism. The main reference international guidelines used were AHA/ASA 2007 (47.4%), followed by ACCP 2008 (21.7%).
  
  
  CONCLUSIONS
  the study showed underutilization of prophylaxis anticoagulants in which mechanical thromboprophylaxis either alone or combination with anticoagulants was the most commonly used. Unfractionated heparin was the preferable choice. The most commonly used guideline was AHA/ASA 2007. VTE thromboprophylaxis in medically ill patients needs to be encouraged.
authors.affiliation: Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
authors.forename: T Djumhana
authors.initials: TD
authors.lastname: Atmakusuma
authors.forename: Karmel L
authors.initials: KL
authors.lastname: Tambunan
authors.forename: Lugyanti
authors.initials: L
authors.lastname: Sukrisman
authors.forename: Shufrie
authors.initials: S
authors.lastname: Effendi
authors.forename: Andhika
authors.initials: A
authors.lastname: Rachman
authors.forename: Arini
authors.initials: A
authors.lastname: Setiawati
authors.forename: Ikhwan
authors.initials: I
authors.lastname: Rinaldi
authors.forename: Nadia A
authors.initials: NA
authors.lastname: Mulansari
authors.forename: Wulyo
authors.initials: W
authors.lastname: Rajabto
authors.forename: Sally A
authors.initials: SA
authors.lastname: Nasution
authors.lastname: Muhadi
authors.forename: Tiara
authors.initials: T
authors.lastname: Aninditha
authors.forename: Rudyanto
authors.initials: R
authors.lastname: Sedono
authors.forename: Adhrie
authors.initials: A
authors.lastname: Sugiarto
authors.forename: Ceva W
authors.initials: CW
authors.lastname: Pitoyo
authors.forename: Diana
authors.initials: D
authors.lastname: Paramitha
authors.forename: Nyoto W
authors.initials: NW
authors.lastname: Astoro
authors.forename: Intan R
authors.initials: IR
authors.lastname: Nasution
mesh_terms: D000208:Acute Disease; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D017984:Enoxaparin / Q000627:therapeutic use*; D005260:Female; D000077425:Fondaparinux; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use*; D006760:Hospitalization; D006801:Humans; D007214:Indonesia; D008297:Male; D008875:Middle Aged; D011134:Polysaccharides / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000517:prevention & control*; D014859:Warfarin / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin; D011134:Polysaccharides; D014859:Warfarin; D006493:Heparin; D000077425:Fondaparinux