Kerbauy Mariana Nassif, de Moraes Fabio Ynoe, Kerbauy Lucila Nassif, Conterno Lucieni de Oliveira, El-Fakhouri Silene
Departamento de Clínica Médica, Escola Paulista de Medicina, Universidade Federal de São Paulo EPM/UNIFESP, São Paulo, SP, Brasil.
Rev Assoc Med Bras (1992). 2013 May-Jun;59(3):258-64. doi: 10.1016/j.ramb.2012.11.008. Epub 2013 May 13.
Routine thromboprophylaxis, despite its well-known effectiveness and the fact that venous thromboembolism is a potentially avoidable condition, is not fully established in clinical practice. The objectives of the present study were to determine how often thromboprophylaxis is used and the presence of thromboembolism risk factors, and to verify the appropriateness of its use in medical inpatients, assuming a long-standing national guideline as a parameter.
This was a retrospective cross-sectional study, involving inpatients with medical conditions in the adult general ward of a university hospital. The review was based on a defined guideline.
146 patients were included in the review. At least one risk factor for venous thromboembolism was found in 94.5%. In 130 (89%) patients, prophylactic heparin was indicated, and some kind of heparin was prescribed in 73.3%. Regarding the adequacy of prophylaxis, 53.4% of prescriptions were correct regarding prophylaxis indication and dose; 24% had incorrect dose or frequency of use; 19.2% had no prophylaxis prescription, although it was indicated; and in five cases (3.4%), the drug was prescribed, even though it was not indicated.
Thromboprophylaxis is underused in this population, and an inappropriate dose was prescribed in 50% of cases. Therefore, future studies and interventions should include an educational program started from the emergency department care, an essential step to bring evidence closer to clinical practice.
