Abstract

DENNIS, Rodolfo J et al. Is current prophylaxis against venous thromboembolism (VTE) appropriate in medical patients?: Evaluation of Colombian outcomes in the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE). Acta Med Colomb [online]. 2009, vol.34, n.1, pp.11-16. ISSN 0120-2448.

Introduction: VTE can be a fatal complication for the acutely ill medical patient who needs hospital care. Pharmacological prophylaxis has been shown to be effective and safe in this context, but little information is available from Latin America on the frequency and rationality of prophylaxis. Objective: to characterize VTE-prophylaxis practices in five Colombian institutions, and to compare them with other centers participating in the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE). Patients and method: consecutive patients older than 18 years old, hospitalized for =3 days with acute medical illnesses, were included. Exclusion criteria included therapeutic use of thrombolytic or antithrombotic agents, trauma, or major surgery within the past three months, as well as VTE within the first 24 hours of hospital care. A central adjudication committee was in charge of allocating relevant events, such as type and duration of prophylaxis, death, VTE episodes, and bleeding. Results: in all, 15.156 patients were included in 52 hospitals in 12 countries, out of which 1948 patients were included in the 5 Colombian centers in Cali and Bogotá. In Colombia, 60% of patients received some type of prophylaxis (versus 50% in the overall international sample, P<0.01). In Colombia, only 39% of patients were candidates for receiving prophylaxis in accordance with the ACCP guidelines, compared with 52% and 43% in the USA and the rest of the international sample respectively. In Colombia, 76% of appropriate candidates (by ACCP guidelines) did receive prophylaxis, compared with just 60% in the international sample. Colombian centers had significantly better outcomes (bleeding, VTE events, and mortality) than the rest of the IMPROVE population. Conclusions: in Colombian centers more prophylaxis to prevent VTE was prescribed in appropriate patients than in all other centers that participated in the international sample, and this may have been associated with better outcomes. However, in Colombia significantly more prophylaxis was also prescribed for patients for whom no evidence of efficacy is available. More efforts are required to increase the rate of prophylaxis, but simultaneously decreasing inappropriate prophylaxis.

Keywords : prophylaxis; venous thromboembolism; clinical practice; guidelines; deep vein thrombosis.

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