Adherence to Guideline of Venous Thromboembolism Prophylaxis in a Level 1 Trauma Center in Thailand

Document Type : Original Article

Authors

Division of Trauma and Critical Care, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand

10.4103/atr.atr_44_17

Abstract

Objective: Venous thromboembolism (VTE) which includes deep vein thrombosis (DVT) and pulmonary embolism is a preventable complication
in hospitalized trauma patients. Currently, the VTE guideline is the standard of care. However, underutilization of the guideline was reported.
This study aimed to report the adherence to the VTE guideline in a Level 1 trauma center in Thailand. Methods: A retrospective review was
performed on adult trauma patients admitted between January and December 2013. The inclusion criteria were Injury Severity Score ≥9 and
admission in the hospital ≥7 days. The patients were classified into “very high risk of DVT,” “high risk of DVT,” and “high risk of bleeding”
groups according to the hospital guideline. Adherence to the guideline, utility of the prophylaxis, and VTE occurrence were recorded.
Results: During a 12-month period, 352 cases met the inclusion criteria. The overall adherence to the guideline was 28.9%, 5.2% in the “very
high risk of DVT” group, 18.4% in the “high risk of DVT” group, and 57.9% in the “high risk of bleeding” group. VTE occurrence was 11
incidences in 10 patients (2.8%). The “high risk of bleeding” group had the highest in VTE occurrence (10 of 11 incidences). Conclusions: The
adherence to the VTE prophylaxis guideline in Thailand was higher than previous studies. The pharmacological prophylaxis should be initiated
as soon as possible.

Keywords


1. Heit JA, Silverstein MD, Mohr DN, Petterson TM, O’Fallon WM, Melton LJ 3rd. Risk factors for deep vein thrombosis and pulmonary embolism: A population‑based case‑control study. Arch Intern Med 2000;160:809‑15.
2. Geerts WH, Code KI, Jay RM, Chen E, Szalai JP. A prospective study of venous thromboembolism after major trauma. N Engl J Med 1994;331:1601‑6. 3. Geerts WH, Jay RM, Code KI, Chen E, Szalai JP, Saibil EA, et al. A comparison of low‑dose heparin with low‑molecular‑weight heparin as prophylaxis against venous thromboembolism after major trauma. N Engl J Med 1996;335:701‑7.
4. Norwood SH, McAuley CE, Berne JD, Vallina VL, Kerns DB, Grahm TW, et al. A potentially expanded role for enoxaparin in preventing venous thromboembolism in high risk blunt trauma patients. J Am Coll Surg 2001;192:161‑7.
5. Gould MK, Garcia DA, Wren SM, Karanicolas PJ, Arcelus JI, Heit JA, et al. Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence‑Based Clinical Practice Guidelines. Chest 2012;141:e227S‑77S.
6. Cohen AT, Tapson VF, Bergmann JF, Goldhaber SZ, Kakkar AK, Deslandes B, et al. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): A multinational cross‑sectional study. Lancet 2008;371:387‑94.
7. Wilasrusmee C, Kiranantawat K, Horsirimanont S, Lertsithichai P, Reodecha P, Soonthonkit Y, et al. Deep venous thrombosis in surgical Intensive Care Unit: Prevalence and risk factors. Asian J Surg 2009;32:85‑8.
8. Prichayudh S, Tumkosit M, Sriussadaporn S, Samorn P, Pak‑art R, Sriussadaporn S, et al. Incidence and associated factors of deep vein thrombosis in Thai surgical ICU patients without chemoprophylaxis: One year study. J Med Assoc Thai 2015;98:472‑8.
9. Wong TH, Koh MP, Ng J. Symptomatic venous thromboembolism in Asian major trauma patients: Incidence, presentation and risk factors. Eur J Trauma Emerg Surg 2013;39:495‑500.
10. Gangireddy C, Rectenwald JR, Upchurch GR, Wakefield TW, Khuri S, Henderson WG, et al. Risk factors and clinical impact of postoperative symptomatic venous thromboembolism. J Vasc Surg 2007;45:335‑41.
11. Xenos ES, Vargas HD, Davenport DL. Association of blood transfusion and venous thromboembolism after colorectal cancer resection. Thromb Res 2012;129:568‑72.