Prevention of venous thromboembolic disease in medical and surgical hospital patients in a single university teaching hospital

Objective: To study hospital-acquired venous thromboembolic disease (HAVTED) and the relationship between its incidence and compliance with thromboprophylaxis protocols. Methods: For the past eight years, specialty-specific protocols for VTE prophylaxis have been in operation throughout this hospital. Patients developing radiologically proven VTE either as inpatients or within 12 weeks of discharge were identified from a register. Patients were categorized according to risk as per the Scottish Intercollegiate Guidelines Network (SIGN) guidelines. The use of pharmacological prophylaxis for VTE was recorded. Results: Over a period of 24 months, 98 patients had radiologically proven HAVTED. Of 44 categorized as high risk, 17 (39%) had received prophylaxis. Corresponding figures for 50 at medium risk and four at low risk were 16 (32%) and three (75%), respectively. The overall incidence of HAVTED averaged two per 1000 inpatient discharges varying between 0.2 in General Medicine and 6.6 in Trauma Orthopaedics. The mean additional cost of treating a case of HAVTED was estimated at £3,000. Conclusion:Audit of radiological investigations of VTE showed that 18% of all cases were hospital acquired. A hospital policy of thromboprophylaxis may reduce but does not eliminate HAVTED. A substantial proportion of patients with HAVTED had not received prophylaxis. The possibility of a further reduction in incidence of HAVTED with potential saving in morbidity, mortality and cost is highlighted. The implementation and efficacy of thromboprophylaxis protocols should be monitored.

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Prevention of Readmission for Venous Thromboembolic Disease after Total Hip Arthroplasty

Yearbook of Orthopedics ◽

10.1016/s0276-1092(08)70119-6 ◽

2007 ◽

Vol 2007 ◽

pp. 116-118

Author(s):

B.F. Morrey

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Thromboembolic Disease ◽

Venous Thromboembolic Disease ◽

Total Hip ◽

Venous Thromboembolic

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Effective risk stratification of surgical and nonsurgical patients for venous thromboembolic disease

Seminars in Hematology ◽

10.1053/shem.2001.25184 ◽

2001 ◽

Vol 38 (2, Suppl 5) ◽

pp. 12-19 ◽

Cited By ~ 18

Author(s):

Joseph A. Caprini ◽

Juan I. Arcelus ◽

Jos[eacute] J. Reyna

Keyword(s):

Risk Stratification ◽

Thromboembolic Disease ◽

Venous Thromboembolic Disease ◽

Venous Thromboembolic ◽

Nonsurgical Patients

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Monitoring Heparin Therapy: Relationships between the Activated Partial Thromboplastin Time and Heparin Assays Based on Ex-Vivo Heparin Samples

Thrombosis and Haemostasis ◽

10.1055/s-0038-1645678 ◽

1990 ◽

Vol 63 (01) ◽

pp. 016-023 ◽

Cited By ~ 41

Author(s):

A M H P van den Bessekaar ◽

J Meeuwisse-Braun ◽

R M Bertina

Keyword(s):

Partial Thromboplastin Time ◽

Plasma Sample ◽

Ex Vivo ◽

Correlation Coefficients ◽

Heparin Therapy ◽

Thromboembolic Disease ◽

Activated Partial Thromboplastin Time ◽

Venous Thromboembolic Disease ◽

Venous Thromboembolic

SummaryFive different APTT reagents, two amidolytic anti-ITa assays, one amidoiytic anti-Xa assay, and one coagulometric anti-Xa/ anti-IIa assay were used to assess the effect of heparin in patients treated for venous thromboembolic disease. Good correlations were observed between lug-transformed APYE> determined with the various reagents (correlation coefficients: 0.92-0.96).Nevertheless there were important differences in the slopes of the lines of relationship between the APTT reagents.Good correlations were observed between the anti-Xa and anti-IIa assay results (correlation coefficients: 0.92-0.97). However, the amidolytic anti-Xa activity was significantly higher (p <0.001) than the two amidolytic anti-IIa activities. Less good correlations were observed between the log-transformed APTTs and the anti-Xa or anti-IIa activities (correlation coefficients: 0.64-0.78). The correlations were improved by transforming the APTT into APTT-ratio, i.e. the ratio of the patient’s APTT to the same patient’s APTT after removal of heparin from the plasma sample by means of ECTEOLA-cellulose treatment. The correlation coefficients of log (AFTT-ratio) with anti-Xa or anti-IIa ranged from 0.76 to 0.87.For both APTT and amidolytic heparin assay, the response to in vitro heparin was different from the response to ex vivo heparin.Therefore, equivalent therapeutic ranges should be assessed by using ex vivo samples rather than in vitro heparin. Because of the response differences between the APTT reagents, it is not adequate to define a therapeutic range for heparin therapy without specification of the reagent.

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