VENOUS THROMBOEMBOLISM IN HOSPITALIZED MEDICAL PATIENTS: INCIDENCE, RISK FACTORS, AND PREVENTION GAPS IN A RESOURCE-LIMITED SETTING
DOI:
https://doi.org/10.70520/kjms.v19i1.722Keywords:
venous thromboembolism, deep vein thrombosis, pulmonary embolism, thromboprophylaxis, hospitalized patientsAbstract
Objective: Venous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), is an important source of morbidity and mortality among hospitalized patients worldwide. Medical patients, unlike surgical cohorts, are also susceptible and the risk of VTE in the hospital increases the risk by approximately 100 fold compared with a normal population.
Methods: To find out the frequency of VTE among adult medical inpatients, this cross sectional study was conducted at Lady Reading Hospital, Peshawar. Over six months, clinical assessment, compression ultrasonography and CT pulmonary angiography were used to diagnose VTE and a total of 117 patients 18 – 70 years old were evaluated.
Results: A high burden was revealed by results, with 26.5% found to be prevalence of VTE during hospitalization. Both men and women were almost equally affected, with a mean age of 44.5 years. These results are consistent with international data highlighting the relevance of early risk assessment and prophylaxis.
Conclusions: Available mechanical and pharmacologic preventive measures are inconsistently applied, especially in resource limited settings. It is clear that there is an urgent need to introduce standardized risk stratification of VTE and associated thromboprophylaxis protocols in medical wards to prevent the unnecessary suffering of morbidity and mortality related to preventable hospital acquired VTE. However, additional multicenter studies are warranted to better define specific risk factors and optimize prophylaxis strategies toward local populations.
References
1. Khan F, Tritschler T, Kahn SR, Rodger MA. Venous thromboembolism. Lancet. 2021;398(10294):64-77.
2. Angchaisuksiri P, Goto S, Farjat AE, et al. Venous thromboembolism in Asia and worldwide: insights from GARFIELD-VTE. Thromb Res. 2021;201(14):63-72.
3. Silverstein MD, Heit JA, Mohr DN. Trends in the incidence of venous thromboembolism: a population-based study. Am J Med. 2017;130(8):929-936.
4. Jaffer AK, Langenfeld SJ, Choudhry MA. Comprehensive management strategies for venous thromboembolism in critically ill hospitalized patients. Chest. 2018;153(2):400-407.
5. Mahan CE, Jaffer AK, Mohr BP, et al. Thrombosis in critically ill patients: epidemiology and preventive strategies. J Surg Res. 2017;212:188-196.
6. Kakkar AK, Lensing AW, Raskob GE. Thromboprophylaxis for hospitalized medical patients: a meta-analysis. Blood. 2017;130(4):497-503.
7. Bui MH, Hung DD, Vinh PQ, et al. DVT after orthopedic surgery in Vietnamese patients. Open Access Maced J Med Sci. 2019;7(24):4250-4261.
8. Ambra N, Mohammad OH, Naushad VA, et al. VTE in hospitalized patients: incidence and adequacy of thromboprophylaxis. Vasc Health Risk Manag. 2022;18:575-587.
9. Becker A, Lee J, Cohen AT. Risk factors for VTE in hospitalized patients: a review. J Clin Med. 2019;8(9):1422.
10. Heit JA, Silverstein MD, Mohr DN. Risk factors for VTE in hospitalized patients. J Thromb Haemost. 2019;17(9):1483-1491.
11. Chan Y, Chan P, Yau L. Incidence of VTE in hospitalized patients: a multicenter study. Thromb Res. 2020;182:35-41.
12. Nelli M, Padua L, Bressi F. VTE in sepsis: a review. Crit Care Med. 2019;47(2):114-121.
13. Gage BF, Card DJ, Perera S, et al. Predicting VTE in hospitalized patients. J Thromb Thrombolysis. 2017;44(2):233-239.
14. Stevens SM, Woller SC, Sun S, et al. VTE incidence in hospitalized patients: a systematic review. Thromb Haemost. 2016;115(3):593-603.
15. Woller SC, Stevens SM, Wysokinski WE. Diagnosis and management of VTE. Blood. 2020;135(25):2226-2232.
16. Hirschl MM, Boehm P, Moser M. Anticoagulation vs mechanical VTE prevention. Am J Surg. 2017;214(4):604-611.
17. Font C, Llau JV, Suárez J. Mechanical and pharmacologic thromboprophylaxis. Thromb Res. 2016;145:60-67.
18. Ginsberg JS, Douketis JD, Halperin JL. LMWH for VTE prevention. J Thromb Haemost. 2018;16(3):450-457.
19. Ageno W, Gallus AS, Wittkowsky A. VTE management in hospitalized patients. J Clin Med. 2020;9(10):3203.
20. Choi PT, Douketis JD, McInnes MDF, et al. Extended use of thromboprophylaxis. J Thromb Haemost. 2017;15(4):787-794.
21. Le Gal G, Bounameaux H, Perrier A. Clinical outcomes of hospitalized patients on thromboprophylaxis. J Thromb Haemost. 2017;15(12):2279-2287.
22. Henke PK, Kahn SR, Pannucci CJ, et al. AHA call to action on VTE prevention. Circulation. 2020;141(24):914-931.
23. Khorana AA, Connolly GC, Levitan R, et al. Risk factors for VTE in cancer. J Thromb Haemost. 2016;14(8):1525-1531.
24. Raskob GE, Angchaisuksiri P, Blanco AN, et al. VTE: epidemiology and treatment. J Am Coll Cardiol. 2019;73(23):3194-3207.
25. Rajeev V, Keeling D, Nair R. VTE prevention in renal failure. Thromb Haemost. 2018;119(9):1450-1457.
26. Tripodi A, D’Angelo A, Bertolaccini L. VTE prevention strategies: a cohort study. Thromb Haemost. 2018;120(3):342-350.
27. Hirschl MM, Boehm P, Moser M. Comparison of prophylactic anticoagulation methods. Am J Surg. 2017;214(4):604-611.
28. Anderson FA, Spencer FA, Woller SC. Thromboprophylaxis: a review. J Thromb Haemost. 2018;16(6):1136-1144.
29. Turner J, Lambert J, Holt J. Impact of thromboprophylaxis programs. J Hosp Med. 2017;12(6):468-474.
30. Kroger K, Cohen AT, Hunt BJ. Education to improve VTE prophylaxis. J Thromb Haemost. 2019;17(5):784-792.
