There is a gap between venous thromboembolism (VTE) prophylaxis utilization and guidelines in hospitals around the world. We developed an educational program using a risk-assessment tool (RAT) for VTE and educational lectures based on the Brazilian Guidelines for VTE Prophylaxis in Medical Patients and evaluated the impact of these tools on the adequacy of VTE prophylaxis.
We performed two cross-sectional surveys before and after the implementation of the program in two private and two public hospitals. During a single-day, all hospitalized medical patients were evaluated to compare the proportion of patients at-risk of VTE and the changes in adequacy of VTE prophylaxis. Adequacy was defined as the use of recommended doses of enoxaparin (40mg/day) or unfractionated-heparin (UFH 5.000IU 8–8h) in at-risk patients.
We compared the data of two groups of medical patients before (n = 219) and after (n = 292) the intervention. The rates of patients with at least one risk factor for VTE and with contra-indications (CI) for heparins were similar: 95% vs. 98% (p = 0.13), and 42% vs. 34% (p = 0.08), respectively. The candidates for prophylaxis were similar in the two groups (75% vs. 82%, p = 0.06), although those candidates with no CI were more prevalent after the program (44% vs. 55%, p = 0.02). After the intervention there was an increase in use of mechanical prophylaxis 0.9% vs. 4.5% (p = 0.03) and a decrease in pharmacological prophylaxis, 55% vs. 48%(p = 0.04). However, there was a significant increase in use of recommended doses 53% vs. 75%, and, a decrease in the use of UFH 5.000 IU 12–12 h, 39% vs. 19% (p < 0.001). Overall, there was a tendency to better adequacy of prophylaxis in private than public hospitals, 64% vs. 56% (p = 0.1).
There is underutilization of VTE prophylaxis among Brazilian hospitals. Strategies based on passive distribution of RAT and educational lectures were not sufficient to improve the utilization, but increased the adequacy of VTE prophylaxis in hospitalized patients.
Multiple and proactive strategies are necessary to improve VTE prophylaxis utilization in hospitalized patients.
Ana Thereza Rocha, Consultant fee, speaker bureau, advisory committee, etc. I am a speaker and member of advisory board for Sanofi-Aventis; No Product/Research Disclosure Information