Department of Surgery, Frere Hospital, East London Hospital Complex, South Africa.
S Afr Med J. 2019 Feb 26;109(3):178-181. doi: 10.7196/SAMJ.2019.v109i3.13510.
Venous thromboembolism (VTE) is a common complication during and after hospitalisation, and is regarded as the most common cause of preventable death in hospitalised patients worldwide. Despite its importance, there are few data on VTE risk and adherence to prophylaxis prescription guidelines in surgical patients from the South African (SA) public sector, especially from low-resource environments such as Eastern Cape Province.
To evaluate the risk and prescription of VTE prophylaxis to surgical patients at a tertiary government hospital in the Eastern Cape.
A cross-sectional clinical audit of general surgical inpatients was performed on two dates during July and August 2017. Patients' VTE risk was calculated by using the Caprini risk assessment model (RAM) and thromboprophylaxis prescription evaluated accordingly.
A total of 179 patients were included in the study, of whom 56% were male and 44% female. The average age was 45 (range 18 - 83) years. Of the total number of participants, 33% were elective cases and 67% were emergency admissions. With application of RAM, 77% of patients were at risk of VTE (Caprini score ≥2), with 81% of elective and 74% of emergency patients being at risk. The most prevalent risk factors for VTE were major surgery (34%), age 41 - 60 years (30%), age 61 - 74 years (20%) and sepsis during the previous month (27%). A contraindication to chemoprophylaxis was recorded in 30% of patients, with the most prevalent being renal dysfunction (40%), peptic ulcer disease (34%), active bleeding (17%), liver dysfunction (17%), coagulopathy (6%) and recent cerebral haemorrhage (6%). With regard to VTE risk profile and contraindications to chemoprophylaxis, the correct thromboprophylactic treatment was prescribed to 26% of at-risk patients, with 21% of elective and 27% of emergency admission patients receiving the correct therapy.
Despite a high proportion of patients being at risk of VTE, the rate of adequate thromboprophylaxis prescription for surgical inpatients at Frere Hospital, East London, SA is very low. Increased availability of mechanical prophylaxis, as well as interventions to improve the rate of adequate prophylaxis prescription, needs to be evaluated for feasibility and effect in this hospital and other SA public hospitals.
静脉血栓栓塞症（VTE）是住院期间和之后的常见并发症，被认为是全球住院患者中最常见的可预防死亡原因。尽管 VTE 很重要，但在南非（SA）公共部门，尤其是在东开普省等资源匮乏的环境中，很少有关于外科患者 VTE 风险和预防用药处方指南遵循情况的数据。
评估东开普省一所三级政府医院外科住院患者的 VTE 风险和预防用药处方情况。
在 2017 年 7 月和 8 月期间的两天进行了一般外科住院患者的横断面临床审核。使用卡普里尼风险评估模型（RAM）计算患者的 VTE 风险，并相应评估抗血栓形成预防用药的处方情况。
共有 179 名患者纳入研究，其中 56%为男性，44%为女性。平均年龄为 45 岁（范围 18-83 岁）。在所有参与者中，33%为择期病例，67%为急诊入院。应用 RAM 后，77%的患者存在 VTE 风险（卡普里尼评分≥2），其中 81%的择期和 74%的急诊患者存在风险。VTE 最常见的危险因素为大手术（34%）、41-60 岁年龄组（30%）、61-74 岁年龄组（20%）和上月发生脓毒症（27%）。有 30%的患者记录有抗凝禁忌证，最常见的是肾功能不全（40%）、消化性溃疡病（34%）、活动性出血（17%）、肝功能不全（17%）、凝血障碍（6%）和近期脑出血（6%）。根据 VTE 风险概况和抗凝禁忌证，对 26%的高危患者开具了正确的抗血栓形成预防治疗药物，其中 21%的择期和 27%的急诊入院患者接受了正确的治疗。
尽管大多数患者存在 VTE 风险，但东伦敦弗雷尔医院南非外科住院患者抗血栓形成预防治疗药物的处方率非常低。需要评估在这家医院和其他南非公立医院中增加机械预防措施的可行性和效果，以及改善适当预防治疗药物处方率的干预措施。
