[Inadequacy of thromboprophylaxis in hospitalized medical patients]

Ana Thereza C Rocha, Priscila Braga, Guilherme Ritt, Antônio Alberto Lopes
Revista da Associação Médica Brasileira 2006, 52 (6): 441-6

BACKGROUND: The risk of venous thromboembolism (VTE) is high in hospitalized patients, however it can be reduced by adequate prophylaxis.

OBJECTIVE: To evaluate the adequacy of VTE prophylaxis in hospitalized medical patients.

METHODS: A cross-sectional study was performed in hospitalized patients with acute medical illnesses in 4 hospitals of Salvador.

RESULTS: We evaluated 226 consecutive patients: 15.5% in medical ICU, 79% > 40 years of age and 48% male. The majority (97%) had a least 1 risk factor (RF) for VTE, 79% had reduced mobility and 62% were diagnosed as having a RF at admission. Of the 208 prophylaxis candidates, 54% received some form of prophylaxis: unfractionated heparin (UFH) in 44%, low molecular weight heparin (LMWH) in 56% and mechanical methods in 2 patients. The utilization rate was similar in private and public hospitals. (51% vs. 49%), but LMWH was more common in private hospitals, without a residence program (97%), and UFH in the public ones (86%). LMWH was more frequently used than UFH in patients > 40 years of age, more often in Caucasian than in Black patients, and less frequently in those with contraindications for heparin. Of the 112 patients receiving prophylaxis, 63% received adequate dosages: LMWH in 95.2% and UFH in 20.4%. VTE prophylaxis was adequate in only 33.6% (70/208) of the patients.

CONCLUSION: Risk Factors for VTE were frequent in medical patients. There was considerable variability of the VTE prophylaxis prescribed in private and public hospitals. LMWH was used more appropriately than UFH. However, only a minority of patients candidates for prophylaxis, received adequate dosages.

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