Mehmet Kurtoglu1. 1. Department of General Surgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey. metlevkurt@superonline.com
Abstract
OBJECTIVE: Venous thromboembolism (VTE) still remains a significant public health problem due to gaps between recommendations and clinical practice in VTE prophylaxis. This is the first clinical study designed to evaluate the applicability of a standard 'VTE prophylaxis and risk factor assessment form (VTE-PRAF)' and prescription of VTE prophylaxis among hospitalized patients in the daily practice of general surgeons in Turkey. METHOD: A total of 1472 patients (mean age: 52.4 ± 16.9 years; 50.6% were men) were included in cross-sectional (n = 537), first longitudinal (n = 452) or the second longitudinal (n = 483) phases. Data on demographics, hospitalization, surgical intervention and prophylaxis were collected during the cross-sectional phase, whereas utilization of form was evaluated during longitudinal phases. RESULTS: While 62.1% of patients were identified to be at 'high+ highest' risk, prophylaxis was evident only for 65.9%. Utilization of the form was higher in the second longitudinal phase (P < 0.001) but there was no relation between implementation of the form and prophylaxis use. VTE-PRAF was completed for 70.6% and 84.8% of patient who received prophylaxis while it was completed for 50.8% and 50.4% of patients with no prophylaxis, in the first and second longitudinal phases, respectively. Prophylaxis was administered in 58.6% and 62.6% of patients with completed VTE-PRAF in the first and second longitudinal phases, respectively. 'Suggested' and 'used' prophylaxis regimens were significantly more consistent for the cases evaluated with VTE-PRAF (P < 0.001). CONCLUSION: Based on the use of prophylaxis only for 65.9% of general surgery inpatients at high risk for VTE, low use of prophylaxis is assumed to remain a significant threat to public health across Turkey. Inclusion of a standard VTE-PRAF in the hospital protocol seems to raise clinical awareness of VTE risk assessment and appropriate management in VTE which otherwise well-known to be associated with significant mortality and morbidity. Impact of e-VTE-PRAF is worth investigating.
OBJECTIVE:Venous thromboembolism (VTE) still remains a significant public health problem due to gaps between recommendations and clinical practice in VTE prophylaxis. This is the first clinical study designed to evaluate the applicability of a standard 'VTE prophylaxis and risk factor assessment form (VTE-PRAF)' and prescription of VTE prophylaxis among hospitalized patients in the daily practice of general surgeons in Turkey. METHOD: A total of 1472 patients (mean age: 52.4 ± 16.9 years; 50.6% were men) were included in cross-sectional (n = 537), first longitudinal (n = 452) or the second longitudinal (n = 483) phases. Data on demographics, hospitalization, surgical intervention and prophylaxis were collected during the cross-sectional phase, whereas utilization of form was evaluated during longitudinal phases. RESULTS: While 62.1% of patients were identified to be at 'high+ highest' risk, prophylaxis was evident only for 65.9%. Utilization of the form was higher in the second longitudinal phase (P < 0.001) but there was no relation between implementation of the form and prophylaxis use. VTE-PRAF was completed for 70.6% and 84.8% of patient who received prophylaxis while it was completed for 50.8% and 50.4% of patients with no prophylaxis, in the first and second longitudinal phases, respectively. Prophylaxis was administered in 58.6% and 62.6% of patients with completed VTE-PRAF in the first and second longitudinal phases, respectively. 'Suggested' and 'used' prophylaxis regimens were significantly more consistent for the cases evaluated with VTE-PRAF (P < 0.001). CONCLUSION: Based on the use of prophylaxis only for 65.9% of general surgery inpatients at high risk for VTE, low use of prophylaxis is assumed to remain a significant threat to public health across Turkey. Inclusion of a standard VTE-PRAF in the hospital protocol seems to raise clinical awareness of VTE risk assessment and appropriate management in VTE which otherwise well-known to be associated with significant mortality and morbidity. Impact of e-VTE-PRAF is worth investigating.