Pharmacy Department, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, West Bank, Palestine.
Vasc Health Risk Manag. 2022 Sep 2;18:701-710. doi: 10.2147/VHRM.S382050. eCollection 2022.
Venous thromboembolism (VTE) is the most preventable complication in hospitalized patients. The main objective of this study was to evaluate the adherence of current clinical practice to the established guidelines at a Palestinian teaching hospital.
This cross-sectional, retrospective, observational study was conducted at a Palestinian Teaching Hospital. The medical records of patients admitted to the medical floor over 18 years of age and hospitalized for longer than 24 hours between January 1 and May 31, 2019, were included. Patients taking anticoagulants with incomplete or duplicated medical records were excluded from the study. A data collection sheet was developed, and clotting and bleeding risks were assessed using the Padua and IMPROVE risk assessment models (scores). The data were analyzed using IBM SPSS (version 25).
In total, 408 patients were included in the study, 222 of whom received thromboprophylaxis (54.4%). Of the hospitalized patients, 112 (27.5%) had a high risk of developing VTE (Padua score ≥ 4), and 73 patients were eligible for VTE pharmacological prophylaxis; however, only 44 (60.3%) received the appropriate prophylaxis. In addition, 296 patients had low Padua scores, indicating that pharmacological prophylaxis was not indicated. However, 144 (48.6%) patients received prophylaxis. The mean Padua and IMPROVE risk scores were 2.25 ± 2.08 and 4.44 ± 2.72, respectively. Among the patients, 17.6% had a high risk of bleeding (IMPROVE score ≥ 7).
VTE prophylaxis among hospitalized medically ill patients was mostly inappropriate; 80.18% of the patients received inappropriate prophylaxis, and only 60.3% of eligible patients received appropriate prophylaxis. Adapting assessment models or checklists in clinical practice based on clinical guidelines for VTE risk stratification is a practical and effective method to improve VTE prophylaxis management and select the appropriate therapy to prevent toxicity or complication.
静脉血栓栓塞症（VTE）是住院患者最可预防的并发症。本研究的主要目的是评估在一家巴勒斯坦教学医院现行临床实践对既定指南的遵循情况。
这是一项在巴勒斯坦教学医院进行的横断面、回顾性、观察性研究。纳入 2019 年 1 月 1 日至 5 月 31 日期间在医疗楼层住院超过 24 小时且年龄在 18 岁以上的患者的病历。排除正在服用抗凝剂且病历不完整或重复的患者。制定了一份数据收集表，并使用 Padua 和 IMPROVE 风险评估模型（评分）评估血栓形成和出血风险。使用 IBM SPSS（版本 25）对数据进行分析。
共有 408 例患者纳入研究，其中 222 例（54.4%）接受了血栓预防治疗。住院患者中，112 例（27.5%）存在发生 VTE 的高风险（Padua 评分≥4），73 例患者适合进行 VTE 药物预防治疗；然而，仅有 44 例（60.3%）接受了适当的预防治疗。此外，296 例患者的 Padua 评分较低，表明不需要药物预防治疗。然而，144 例（48.6%）患者仍接受了预防治疗。患者的平均 Padua 和 IMPROVE 风险评分分别为 2.25±2.08 和 4.44±2.72。患者中有 17.6%（73 例）存在出血高风险（IMPROVE 评分≥7）。
住院内科患者的 VTE 预防治疗大多不恰当；80.18%的患者接受了不适当的预防治疗，仅有 60.3%的符合条件的患者接受了适当的预防治疗。根据 VTE 风险分层的临床指南，在临床实践中采用评估模型或检查表，是改善 VTE 预防治疗管理和选择适当治疗方法以预防毒性或并发症的一种实用且有效的方法。
