Assessment of thromboprophylaxis in medical patients hospitalized in Andalusia. A multicenter study

M A Navarro Puerto; F J Medrano Ortega; R Izquierdo Guerrero; E Calderón Sandubete; M L Buzón-Barrera; I Marín-León; en nombre del GRUPO COLABORATIVO PRETEMED

doi:10.1016/j.rce.2014.09.007

Assessment of thromboprophylaxis in medical patients hospitalized in Andalusia. A multicenter study

Rev Clin Esp (Barc). 2015 Apr;215(3):141-7. doi: 10.1016/j.rce.2014.09.007. Epub 2014 Nov 20.

[Article in English, Spanish]

Authors

M A Navarro Puerto¹, F J Medrano Ortega², R Izquierdo Guerrero³, E Calderón Sandubete², M L Buzón-Barrera⁴, I Marín-León⁵; en nombre del GRUPO COLABORATIVO PRETEMED

Affiliations

¹ Servicio de Medicina Interna, Hospital Universitario Valme, Sevilla, España.
² Servicio de Medicina Interna, Hospital Universitario Virgen Rocío, Sevilla, España; IBIS-CSIC-US-CIBERESP, Sevilla, España.
³ Servicio de Medicina Interna, Hospital Universitario Virgen Rocío, Sevilla, España.
⁴ Fundación Enebro, Sevilla, España.
⁵ Servicio de Medicina Interna, Hospital Universitario Virgen Rocío, Sevilla, España; IBIS-CSIC-US-CIBERESP, Sevilla, España; Fundación Enebro, Sevilla, España. Electronic address: ignacio.marin.sspa@juntadeandalucia.es.

PMID: 25439187
DOI: 10.1016/j.rce.2014.09.007

Abstract

Background and objectives: Hospitalized patients are a population at risk for venous thromboembolism (VTE). The PRETEMED-2007 clinical practice guidelines help identify high-risk medical patients who are suited to thromboprophylaxis. These guidelines therefore provide a standard for prophylaxis in such patients. We evaluated the risk of VTE and the adjustment of thromboprophylaxis to the standards of the PRETEMED-2007 guidelines in patients hospitalized in internal medicine departments.

Patients and methods: An observational, cross-sectional multicenter study was performed in 2010 in 16 hospitals in Andalusia and included 20 consecutive patients per center. The study variables were age, sex, risk factors for VTE and hemorrhage, the risk-adjusted PRETEMED of VTE, adjustment of thromboembolic prophylaxis at admission and at discharge and hospital mortality.

Results: The study included 293 patients (57.8% men) with a mean age of 69 (±15) years. The most common triggers for VTE were acute severe infection (27.3%) and neoplasia (16.4%). Some 43.4% of the patients presented a risk of hemorrhage. The risk of VTE at admission and discharge was high in 47.8% and 31% and moderate in 8.2% and 10.6%, respectively. A total of 91.7% and 17.3% of the patients underwent prophylaxis with low-molecular-weight heparin on admission and at discharge, respectively. The prescription was appropriate for 59.9% of the patients at admission (overutilization 38.4%, underutilization 1.7%) and for 74.7% at discharge (overutilization 5.4%, underutilization 19.9%). The adjustment was greater in patients older than 60 years and with greater hemorrhagic risk.

Conclusions: For 60% of the patients admitted to the departments of internal medicine in Andalusia, the thromboprophylaxis was appropriate. The inadequacy of thromboprophylaxis (40%) is mostly due to overutilization. These results suggest significant space for improvement.

Keywords: Adecuación tratamiento; Clinical guidelines; Guías clínicas; Profilaxis; Prophylaxis; Treatment adjustment; Trombosis venosa; Venous thrombosis.