Venous Thromboembolism Risk Assessment and Thromboprophylaxis Practice in Hospitalized Medical Patients: The Experience of a Singapore Teaching Hospital

Abstract

Despite the availability of institutional guidelines, the practice of venous thromboembolism (VTE) risk assessment and thromboprophylaxis remains inadequate in Singapore. With hospital-associated VTE (HA-VTE) being a common cause of preventable mortality for medical patients, it is vital for prompt, appropriate prescription of thromboprophylaxis after VTE risk assessment. This study aimed to (1) assess the local practice of VTE risk assessment and prophylaxis according to institutional guidelines, (2) study the risk factors of potential preventable HA-VTE among hospitalized medical patients, and (3) improve the quality of care with respect to early prevention of HA-VTE. An audit was performed on daily new admissions to two general medical wards in a teaching hospital in Singapore (total capacity of 76 beds) over 2 weeks. Each new admission's medical records were reviewed to examine whether (1) VTE risk assessment was performed by the managing medical teams, (2) thromboprophylaxis was prescribed during admission in high VTE risk patients, and (3) any contraindications to pharmacological thromboprophylaxis for cases with high VTE risk but no pharmacological thromboprophylaxis prescribed was present. Only 1 out of 52 cases had VTE risk assessment performed. Thirty-one cases (59.1%) were identified to have high VTE risk using the Padua Prediction Score. However, only 1 out of the 31 cases (3.2%) had VTE prophylaxis prescribed. Adherence to local institutional guidelines remains poor despite increasing awareness of the importance of VTE risk assessment and prophylaxis in the prevention of associated morbidity and mortality. Certain patient profiles should prompt clinicians to perform VTE risk assessment.

Keywords

venous thromboembolism - thromboprophylaxis - risk assessment - anticoagulants - hospitalized patients

Publikationsverlauf

Artikel online veröffentlicht:
30. September 2024

• References

• 1 Wang KL, Yap ES, Goto S, Zhang S, Siu CW, Chiang CE. The diagnosis and treatment of venous thromboembolism in Asian patients. Thromb J 2018; 16: 4
• 2 Liew NC, Chang YH, Choi G. et al; Asian Venous Thrombosis Forum. Asian venous thromboembolism guidelines: prevention of venous thromboembolism. Int Angiol 2012; 31 (06) 501-516
• 3 Cohen AT, Alikhan R, Arcelus JI. et al. Assessment of venous thromboembolism risk and the benefits of thromboprophylaxis in medical patients. Thromb Haemost 2005; 94 (04) 750-759
• 4 Er C, Kuthiah N, Adamjee T, Tay JC. Venous thromboembolism risk assessment and thromboprophylaxis practice in general medical patients requiring admissions to general wards: a Singapore's perspective. Int J Angiol 2021; 30 (04) 299-304
• 5 Expert Consultation WHO. WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004; 363 (9403) 157-163
• 6 Er C, Kuthiah N, Adamjee T, Tay JC. Venous thromboembolism risk assessment and thromboprophylaxis practice in general medical patients requiring admissions to general wards: a Singapore's perspective, part 2. Int J Angiol 2021; 32 (02) 146-152 . Accessed September 13, 2024 at: https://doi.org/10.1055/s-0041-1730448
• 7 Lavon O, Tamir T. Evaluation of the Padua Prediction Score ability to predict venous thromboembolism in Israeli non-surgical hospitalized patients using electronic medical records. Sci Rep 2022; 12 (01) 6121
• 8 Er C, Cohen AT. Limitations of venous thromboembolism risk assessment models in medical patients: Response to “Unmet definitions in thromboprophylaxis for hospitalized medical patients: an appraisal for the need of recommendation”. Res Pract Thromb Haemost 2023; 7 (01) 100027
• 9 Cobben RRC, Nemeth B, Lijfering WM, Cannegieter SC. Validation of risk assessment models for venous thrombosis in hospitalized medical patients. Res Pract Thromb Haemost 2019; 3 (02) 217-225