A Cross-sectional, Multicenter, Observational Study to Assess the Prophylaxis of Venous Thromboembolism in Lebanese and Jordanian Hospitals

Abstract BackgroundThere is a growing body of evidence showing substantial underuse of appropriate venous thromboembolism (VTE) prophylaxis in patients at risk. In the present study, our goal was to assess the current practices in the use rate of VTE prophylaxis among hospitalized patients in Jordan and Lebanon.MethodsA cross-sectional, multicenter, observational study was conducted on 40 centers across Lebanon and Jordan. We included patients who were admitted to the participating hospitals for the treatment of a serious medical or surgical illness. The patients’ records were screened for the fulfillment of inclusion/exclusion criteria during a single assessment visit. The proportion of medical and surgical patients who were at risk of VTE and the thrombo-prophylactic measures employed by physicians for these patients were assessed according to the American College of Chest Physicians (ACCP 2016) guidelines. ResultsThe present study included 704 patients (400 from Jordan and 304 from Lebanon) with a mean age of 54.9 ±17.5 years. Almost 59% of the patients received prophylaxis treatment in form of pharmacological anticoagulant prophylaxis and/or mechanical prophylaxis. Low molecular weight heparin was the most commonly used anticoagulant for VTE prophylaxis in 366 out of the total 704 (51.9%) patients in the analysis cohort. Two hundred and sixteen patients (52 %, 95% confidence interval [47.1% - 56.9%]) received appropriate prophylactic agents out of 415 patients who were eligible for prophylaxis according to the ACCP 2016 guidelines. On the other hand, 199 (72.1%, 95% confidence interval [66.4% – 77.3%) patients received prophylaxis out of 276 ineligible patients. The rate of compliance to guidelines showed wide variations according to the type of hospital, specialty, and the patients’ age. The multivariate logistic regression analysis showed that only age was a significant predictor of appropriate VTE prophylaxis (odds ratio [OR] 1.05, P <0.001).ConclusionThe rates of the appropriate use of VTE prophylaxis are low in Lebanon and Jordan. There is a lack of compliance to guidelines for VTE prophylaxis use for hospitalized patients in both countries.

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A cross-sectional, multicenter, observational study to assess the prophylaxis of venous thromboembolism in Lebanese and Jordanian hospitals

Thrombosis Journal ◽

10.1186/s12959-021-00261-2 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Imad Hajj ◽

Mahmoud AL-Masri ◽

Kaldoun Bashaireh ◽

Mohammed Bani Hani ◽

Shadi Hamouri ◽

...

Keyword(s):

At Risk ◽

Venous Thromboembolism ◽

Observational Study ◽

Confidence Interval ◽

Multivariate Logistic Regression Analysis ◽

Hospitalized Patients ◽

Cross Sectional ◽

Multicenter Observational Study ◽

Vte Prophylaxis ◽

Prophylactic Measures

Abstract Background There is a growing body of evidence showing substantial underuse of appropriate venous thromboembolism (VTE) prophylaxis in patients at risk. In the present study, our goal was to assess the current practices in the use rate of VTE prophylaxis among hospitalized patients in Jordan and Lebanon. Methods A cross-sectional, multicenter, observational study was conducted on 40 centers across Lebanon and Jordan. We included patients who were admitted to the participating hospitals for the treatment of a serious medical or surgical illness. The patients’ records were screened for the fulfillment of inclusion/exclusion criteria during a single assessment visit. The proportion of medical and surgical patients who were at risk of VTE and the thrombo-prophylactic measures employed by physicians for these patients were assessed according to the American College of Chest Physicians (ACCP 2016) guidelines. Results The present study included 704 patients (400 from Jordan and 304 from Lebanon) with a mean age of 54.9 ± 17.5 years. Almost 59% of the patients received prophylaxis treatment in form of pharmacological anticoagulant prophylaxis and/or mechanical prophylaxis. Low molecular weight heparin was the most commonly used anticoagulant for VTE prophylaxis in 366 out of the total 704 (51.9%) patients in the analysis cohort. Two hundred and sixteen patients (52, 95% confidence interval [47.1–56.9%]) received appropriate prophylactic agents out of 415 patients who were eligible for prophylaxis according to the ACCP 2016 guidelines. On the other hand, 199 (72.1, 95% confidence interval [66.4–77.3%) patients received prophylaxis out of 276 ineligible patients. The rate of compliance to guidelines showed wide variations according to the type of hospital, specialty, and the patients’ age. The multivariate logistic regression analysis showed that only age was a significant predictor of appropriate VTE prophylaxis (odds ratio [OR] 1.05, P < 0.001). Conclusion The rates of the appropriate use of VTE prophylaxis are low in Lebanon and Jordan. There is a lack of compliance to guidelines for VTE prophylaxis use for hospitalized patients in both countries.

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A Cross-sectional, Multicenter, Observational Study to Assess the Prophylaxis of Venous Thromboembolism in Lebanese and Jordanian Hospitals

10.21203/rs.3.rs-42401/v1 ◽

2020 ◽

Author(s):

Imad Hajj ◽

Mahmoud AL -Masri ◽

Kaldoun Bashaireh ◽

Mohammed Bani Hani ◽

Shadi Hamouri ◽

...

Keyword(s):

At Risk ◽

Venous Thromboembolism ◽

Observational Study ◽

Confidence Interval ◽

Multivariate Logistic Regression Analysis ◽

Hospitalized Patients ◽

Cross Sectional ◽

Multicenter Observational Study ◽

Vte Prophylaxis ◽

Prophylactic Measures

Abstract Background There is a growing body of evidence showing substantial underuse of appropriate venous thromboembolism (VTE) prophylaxis in patients at risk. In the present study, our goal was to assess the current practices in the use rate of VTE prophylaxis among hospitalized patients in Jordan and Lebanon. Methods A cross-sectional, multicenter, observational study was conducted on 40 centers across Lebanon and Jordan. We included patients who were admitted to the participating hospitals for the treatment of a serious medical or surgical illness. The patients’ records were screened for the fulfillment of inclusion/exclusion criteria during a single assessment visit. The proportion of medical and surgical patients who were at risk of VTE and the thrombo-prophylactic measures employed by physicians for these patients were assessed according to the American College of Chest Physicians (ACCP 2016) guidelines. Results The present study included 704 patients (400 from Jordan and 304 from Lebanon) with a mean age of 54.9 ± 17.5 years. Almost 59% of the patients received prophylaxis treatment in form of pharmacological anticoagulant prophylaxis and/or mechanical prophylaxis. Low molecular weight heparin was the most commonly used anticoagulant for VTE prophylaxis in 366 out of the total 704 (51.9%) patients in the analysis cohort. Two hundred and sixteen patients (52%, 95% confidence interval [47.1% − 56.9%]) received appropriate prophylactic agents out of 415 patients who were eligible for prophylaxis according to the ACCP 2016 guidelines. On the other hand, 199 (72.1%, 95% confidence interval [66.4% – 77.3%) patients received prophylaxis out of 276 ineligible patients.. The rate of compliance to guidelines showed wide variations according to the type of hospital, specialty, and the patients’ age. The multivariate logistic regression analysis showed that only age was a significant predictor of appropriate VTE prophylaxis (odds ratio [OR] 1.05, P < 0.001). Conclusion The rates of the appropriate use of VTE prophylaxis are low in Lebanon and Jordan. There is a lack of compliance to guidelines for VTE prophylaxis use for hospitalized patients in both countries.

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A Cross-sectional, Multicenter, Observational Study to Assess the Prophylaxis of Venous Thromboembolism in Lebanese and Jordanian Hospitals

10.21203/rs.3.rs-42401/v2 ◽

2020 ◽

Author(s):

Imad Hajj ◽

Mahmoud AL -Masri ◽

Kaldoun Bashaireh ◽

Mohammed Bani Hani ◽

Shadi Hamouri ◽

...

Keyword(s):

At Risk ◽

Venous Thromboembolism ◽

Observational Study ◽

Confidence Interval ◽

Multivariate Logistic Regression Analysis ◽

Hospitalized Patients ◽

Cross Sectional ◽

Multicenter Observational Study ◽

Vte Prophylaxis ◽

Prophylactic Measures

Abstract Background There is a growing body of evidence showing substantial underuse of appropriate venous thromboembolism (VTE) prophylaxis in patients at risk. In the present study, our goal was to assess the current practices in the use rate of VTE prophylaxis among hospitalized patients in Jordan and Lebanon.Methods A cross-sectional, multicenter, observational study was conducted on 40 centers across Lebanon and Jordan. We included patients who were admitted to the participating hospitals for the treatment of a serious medical or surgical illness. The patients’ records were screened for the fulfillment of inclusion/exclusion criteria during a single assessment visit. The proportion of medical and surgical patients who were at risk of VTE and the thrombo-prophylactic measures employed by physicians for these patients were assessed according to the American College of Chest Physicians (ACCP 2016) guidelines. Results The present study included 704 patients (400 from Jordan and 304 from Lebanon) with a mean age of 54.9 ±17.5 years. Almost 59% of the patients received prophylaxis treatment in form of pharmacological anticoagulant prophylaxis and/or mechanical prophylaxis. Low molecular weight heparin was the most commonly used anticoagulant for VTE prophylaxis in 366 out of the total 704 (51.9%) patients in the analysis cohort. Two hundred and sixteen patients (52 %, 95% confidence interval [47.1% - 56.9%]) received appropriate prophylactic agents out of 415 patients who were eligible for prophylaxis according to the ACCP 2016 guidelines. On the other hand, 199 (72.1%, 95% confidence interval [66.4% – 77.3%) patients received prophylaxis out of 276 ineligible patients.. The rate of compliance to guidelines showed wide variations according to the type of hospital, specialty, and the patients’ age. The multivariate logistic regression analysis showed that only age was a significant predictor of appropriate VTE prophylaxis (odds ratio [OR] 1.05, P <0.001).Conclusion The rates of the appropriate use of VTE prophylaxis are low in Lebanon and Jordan. There is a lack of compliance to guidelines for VTE prophylaxis use for hospitalized patients in both countries.

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A Cross-sectional, Multicenter, Observational Study to Assess the Prophylaxis of Venous Thromboembolism in Lebanese and Jordanian Hospitals

10.21203/rs.3.rs-42401/v3 ◽

2021 ◽

Author(s):

Imad Hajj ◽

Mahmoud AL -Masri ◽

Kaldoun Bashaireh ◽

Mohammed Bani Hani ◽

Shadi Hamouri ◽

...

Keyword(s):

At Risk ◽

Venous Thromboembolism ◽

Observational Study ◽

Confidence Interval ◽

Multivariate Logistic Regression Analysis ◽

Hospitalized Patients ◽

Cross Sectional ◽

Multicenter Observational Study ◽

Vte Prophylaxis ◽

Prophylactic Measures

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Use of thromboprophylaxis for venous thromboembolism among patients admitted in medical ward

Journal of Patan Academy of Health Sciences ◽

10.3126/jpahs.v6i1.27087 ◽

2019 ◽

Vol 6 (1) ◽

pp. 83-88

Author(s):

Ujjawal Paudel ◽

Prashant Raj Bhatt ◽

Choodamani Nepal

Keyword(s):

At Risk ◽

Venous Thromboembolism ◽

Acute Infection ◽

Tertiary Care ◽

Medical Ward ◽

Assessment Model ◽

Medical Patients ◽

Cross Sectional ◽

Vte Prophylaxis ◽

Risk Of Bleeding

Introductions: Studies have shown inadequate use of prophylaxis for venous thromboembolism (VTE) in hospital admitted medical patients. This study aims to evaluate the use of VTE prophylaxis in admitted medical patients in a tertiary care teaching hospital. Methods: This was a cross sectional observational study for three weeks from 19 March to 8 April 2017 in patients admitted in the medical ward of Patan Hospital, Patan Academy of Health Sciences, Lalitpur, Nepal. Patient charts were reviewed for appropriate VTE prophylaxis as per modified Padua risk Assessment model. Risks of VTE, presence of bleeding risks, demographics (age, BMI), hospital stay were descriptively analysed. Results: Out of 122 patients, 81 (66.4%) were at risk of VTE. Among 81 at risk, 69 were eligible for VTE pharmacoprophylaxis with no risk of bleeding only 29 (42%) received pharmacoprophylaxis and 12 eligible for prophylaxis but with the risk of bleeding did not receive any prophylaxis. Reduced mobility was the most common indication of thromboprophylaxis in 79 (64%), followed by acute infection 50 (41%). Conclusions: There was suboptimal use of thromboprophylaxis in hospital admitted medical patients at risk of venous thromboembolism, VTE.

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Assessment of arterial stiffness in patients with venous thromboembolism: Separate or continuous circuits?

Phlebology The Journal of Venous Disease ◽

10.1177/0268355516652033 ◽

2016 ◽

Vol 32 (5) ◽

pp. 316-321 ◽

Cited By ~ 1

Author(s):

Ahmet Çağrı Aykan ◽

Engin Hatem ◽

Ezgi Kalaycıoğlu ◽

Tayyar Gökdeniz ◽

Can Yucel Karabay

Keyword(s):

Venous Thromboembolism ◽

Arterial Stiffness ◽

Confidence Interval ◽

Operating Characteristic ◽

Characteristic Curve ◽

Multivariate Logistic Regression Analysis ◽

Index Method ◽

Cross Sectional ◽

Venous Circulation ◽

Index Value

Objectives The aim of this study is to evaluate the association of venous thromboembolism with arterial stiffness by cardio-ankle vascular index method. Method We included 52 patients with a documented lower extremity venous thromboembolism within the last six months and 52 healthy subjects to this cross sectional observational study. Results Cardio-ankle vascular index (8.58 ± 1.60 versus 7.05 ± 1.44, p < 0.001, respectively) and systolic blood pressure (128.02 ± 7.13 mmHg versus 123.94 ± 8.12 mmHg, p = 0.008, respectively) were significantly higher among patients with venous thromboembolism than controls. Cardio-ankle vascular index was an independent predictor of venous thromboembolism in multivariate logistic regression analysis (p < 0.001, odds ratio = 1.864, 95% confidence interval = 1.370–2.536). Cardio-ankle vascular index value > 7.8 had a sensitivity of 82.7% and a specificity of 80.8% for predicting venous thromboembolism (area under curve = 0.789, 95% confidence interval = 0.698–0.863, p < 0.001) in receiver operating characteristic curve analysis. Conclusion We found that arterial stiffness was increased in patients with venous thromboembolism which highlights the fact that arterial and venous circulation is in continuum and an insult may affect both of these circuits.

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An observational study for venous thromboembolism risk assessment among hospitalized patients in general surgery clinics across Turkey

Phlebology The Journal of Venous Disease ◽

10.1258/phleb.2010.010064 ◽

2011 ◽

Vol 26 (8) ◽

pp. 344-352 ◽

Cited By ~ 3

Author(s):

Mehmet Kurtoglu

Keyword(s):

Public Health ◽

Risk Assessment ◽

Venous Thromboembolism ◽

General Surgery ◽

Public Health Problem ◽

Hospitalized Patients ◽

Cross Sectional ◽

Mortality And Morbidity ◽

Vte Prophylaxis ◽

Clinical Awareness

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.

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A Prospective Multicenter Observational Study of Venous Thromboembolism after Gastric Cancer Surgery (SHISA-1601)

European Surgical Research ◽

10.1159/000514309 ◽

2021 ◽

pp. 1-10

Author(s):

Sachiko Kaida ◽

Toru Miyake ◽

Satoshi Murata ◽

Tsuyoshi Yamaguchi ◽

Takeshi Tatsuta ◽

...

Keyword(s):

Gastric Cancer ◽

Venous Thromboembolism ◽

Blood Transfusion ◽

Observational Study ◽

Characteristic Curve ◽

Cancer Surgery ◽

Gastric Cancer Surgery ◽

Multicenter Observational Study ◽

Prospective Multicenter Observational Study ◽

D Dimer

Introduction: This study aimed to clarify the frequency and risk factors of intercurrent venous thromboembolism (VTE) in patients undergoing major curative gastric cancer surgery. Methods: This prospective, multicenter, observational study included patients with gastric cancer who underwent radical gastrectomy at 5 hospitals between June 2016 and May 2018. Patients who were preoperatively administered anticoagulants were excluded. Results: A total of 126 patients were eligible to participate. VTE occurred within 9 days postoperatively in 5 cases (4.0%; 2 symptomatic and 3 asymptomatic). Postoperative day (POD) 1 plasma D-dimer and soluble fibrin (SF) levels were significantly higher in the VTE group than in the non-VTE group. Receiver-operating characteristic curve (ROC) analysis indicated a statistically significant ability of POD 1 D-dimer and SF levels to predict postoperative VTE development after gastrectomy; this finding was reflected by an area under the curve (AUC) of 0.97 (95% CI 0.92–1.0) and 0.87 (95% CI 0.74–1.0), respectively. Cutoff values of D-dimer (24.6 µg/mL) and SF (64.1 µg/mL) were determined. Intraoperative blood transfusion (odds ratio [OR] 7.86), POD 1 D-dimer ≥24.6 µg/mL (OR 17.35), and POD 1 SF ≥64.1 µg/mL (OR 19.5) were independent predictive factors for postoperative VTE (p < 0.05). Conclusion: VTE occurred in 4.0% patients (1.6% symptomatic and 2.4% asymptomatic) after gastric cancer surgery; however, with an early diagnosis and anticoagulant therapy, no patients experienced progression. Careful observation of patients with a high risk for VTE, including intraoperative blood transfusion and high POD 1 D-dimer or SF levels, would contribute to the early detection of VTE.

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