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Pulmonary Vascular Disease |

Comparison of the Use and Efficacy of Mechanical and Pharmacological Prophylaxis for Venous Thromboembolism in Hospitalized Patients FREE TO VIEW

Eduardo Sad; Maria Chindamo; Fernando Afonso; Oneide Silva; Kelviane Baêta; Wagner Schiavinni
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Critical Care, Hospital Barra Dor, Belo Horizonte, Minas Gerais, Brazil


Chest. 2014;146(4_MeetingAbstracts):820A. doi:10.1378/chest.1990929
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Abstract

SESSION TITLE: DVT/PE/Pulmonary Hypertension Posters I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: In hospitalised patients with contraindications to pharmacological thromboprophylaxis,despite the uncertain benefit, mechanical prophylaxis may be preferable to no prophylaxis. The correct indication and use of mechanical prophylaxis measures (intermittent pneumatic compression boot- IPC) is a challenge. The aims of this study were to evaluate the adherence to mechanical prophylaxis, as recommended in the literature (longer than 18h/day), and compare the rate of VTE in patients using mechanical prophylaxis with those on pharmacological use.

METHODS: VTE events during hospitalization were assessed from October 2012 to September 2013 and were analyzed and correlated with prevention practices offered to each patient. A form was elaborated and applied to all patients with indication for IPC, from March to September 2013, containing identification of the patient, indication for use of IPC, total time of use in 24h, and appropriate size of the inflatable garment according to the thigh circumference. Adherence to the correct use of mechanical prophylaxis was evaluated regularly.

RESULTS: From October 2012 to September 2013, 5819 patients on VTE prophylaxis were evaluated during hospitalization. The majority of patients were on pharmacological prophylaxis, with enoxaparin (5533 patients). A total of 19 VTE events were reported during this period of follow-up representing an incidence rate of VTE of 0,34%. Ten VTE events occurred in the group on pharmacological prophylaxis (0,18%) whereas 9 events occurred in 286 patients receiving mechanical prophylaxis (3,14%). Thus, the risk of VTE was 18 times higher in patients on mechanical prophylaxis in comparison with those using pharmacological prophylaxis (RR= 17,94; IC 7,23 - 44,5; p<0,001). We had 95% adherence rate to the use of IPC for more than 18h/day. The main indications for mechanical devices were bleeding and thrombocytopenia. Pressure ulcers resulting from the use of IPC were not observed in this period.

CONCLUSIONS: IPC device is a less effective alternative when compared to pharmacological prophylaxis in the prevention of VTE.

CLINICAL IMPLICATIONS: IPC device is a less effective alternative when compared to pharmacological prophylaxis in the prevention of VTE.Its use is better than no prophylaxis but, the pharmacological prophylaxis should be started as soon as possible.

DISCLOSURE: The following authors have nothing to disclose: Eduardo Sad, Maria Chindamo, Fernando Afonso, Oneide Silva, Kelviane Baêta, Wagner Schiavinni

No Product/Research Disclosure Information


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