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Venous thromboembolism risk and prophylaxis in hospitalised medically ill patients

Journal: Thrombosis and Haemostasis
ISSN: 0340-6245
DOI: http://dx.doi.org/10.1160/TH09-09-0667
Issue: 2010: 103/4 (Apr) pp. 683–873
Pages: 736-748

Venous thromboembolism risk and prophylaxis in hospitalised medically ill patients

The ENDORSE Global Survey

Online Supplementary Material

J.-F. Bergmann (1), A. T. Cohen (2), V. F. Tapson (3), S. Z. Goldhaber (4), A. K. Kakkar (5), B. Deslandes (6), W. Huang (7), F. A. Anderson Jr. (7)
for the ENDORSE Investigators

(1) Hôpital Lariboisière, University Paris 7, Paris, France; (2) King’s College Hospital, London, UK; (3) Duke University Medical Center, Durham, North Carolina, USA; (4) Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA; (5) Thrombosis Research Institute, London, UK and Queen Mary University of London, London, UK; (6) sanofi-aventis, Paris, France; (7) Center for Outcomes Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA

Summary

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.

Keywords

venous thromboembolism, prophylaxis, ACCP guideline use, ENDORSE, hospitalised medical patients

DOI

http://dx.doi.org/10.1160/TH09-09-0667

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