Geahchan Negib, Basile Melkart, Tohmeh Maroon
Faculty of Medicine, Saint Joseph University, Damascus street, Riad El Solh, P.O.Box 11-5076, Beirut, 1107 2180 Lebanon.
Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon.
Springerplus. 2016 Sep 13;5(1):1541. doi: 10.1186/s40064-016-3057-9. eCollection 2016.
Venous thromboembolism (VTE) is a major health care problem resulting in significant mortality, morbidity and increase in medical expenses. Patients with malignant diseases represent a high risk population for VTE. The American College of Chest Physicians (ACCP) proposed, since 1986, prophylaxis guidelines that are unequally respected in surgical practice.
DIONYS is a multinational, longitudinal and non-interventional registry including patients having undergone abdominal or pelvic surgery for cancer in Latin America, Africa and the Middle East. Patients were evaluated with regard to VTE prophylaxis, during three consecutive visits, for their adherence to ACCP 2008 guidelines. Data were collected on type and duration of VTE prophylaxis, adherence to guidelines, and compliance with prescriptions, complications and possible reasons for omission of prophylaxis.
Between 2011 and June 2012, 921 adult patients were included and divided into abdominal (435), pelvic (390) and combined abdominal and pelvic surgery (96), 65.4 % being females. VTE prophylaxis was prescribed to 90 % of patients during hospitalization and to 28.3 % after hospital discharge. Prescriptions adhered to ACCP guidelines in 73.9 % of patients during hospitalization and 18.9 % after discharge. The reason of non-adherence was mainly the clinical judgment by the physician that the patient did not need a prophylaxis. The most commonly prescribed type of prophylaxis was pharmacological (low molecular weight heparin).
A wide gap exists between VTE prophylaxis in daily practice and the ACCP 2008 guidelines, in abdominal and pelvic cancer surgery. A better awareness of surgeons is probably the best guarantee for improvement of VTE prophylaxis in surgical wards.
静脉血栓栓塞症（VTE）是一个重大的医疗保健问题，会导致显著的死亡率、发病率和医疗费用增加。恶性疾病患者是VTE的高危人群。自1986年以来，美国胸科医师学会（ACCP）提出了预防指南，但在外科实践中并未得到同等程度的遵循。
DIONYS是一项多中心、纵向、非干预性登记研究，纳入了拉丁美洲、非洲和中东地区因癌症接受腹部或盆腔手术的患者。在连续三次就诊时，对患者的VTE预防情况进行评估，以了解他们对ACCP 2008指南的遵循情况。收集了VTE预防的类型和持续时间、对指南的遵循情况、处方依从性、并发症以及预防措施遗漏的可能原因等数据。
2011年至2012年6月期间，共纳入921例成年患者，分为腹部手术组（435例）、盆腔手术组（390例）和腹部及盆腔联合手术组（96例），女性占65.4%。90%的患者在住院期间接受了VTE预防，28.3%的患者在出院后接受了预防。住院期间73.9%的患者处方符合ACCP指南，出院后为18.9%。不遵循的主要原因是医生根据临床判断认为患者不需要预防。最常用的预防类型是药物预防（低分子量肝素）。
在腹部和盆腔癌症手术的日常实践中，VTE预防与ACCP 2008指南之间存在很大差距。提高外科医生的认识可能是改善外科病房VTE预防的最佳保障。
