Managing Venous Thromboembolism in Latin American Patients: Emerging Results from the Brazilian Registry

Abstract

A Brazilian National Registry was established in 1999 to investigate the incidence of risk factors for venous thromboembolism (VTE) in hospitalized medical and surgical patients and to investigate the use of thromboprophylaxis in these populations. A 4-year pilot study confirmed the feasibility and value of a registry project in this region, showing a dramatic increase in the use of low-molecular-weight heparin (LMWH) over the study period, associated with a sixfold reduction in the incidence of symptomatic VTE. Data on more than 27,000 patients from the Brazilian Registry have revealed that almost 25% of high-risk patients and 45% of those at moderate risk currently receive no thromboprophylaxis. Among the high-risk patients-in whom general measures alone are not considered appropriate prophylaxis-42% of patients did not receive pharmacological prophylaxis with either LMWH or unfractionated heparin. The Brazilian Registry highlights the need to raise awareness of VTE risk factors and recommended prophylactic regimens in Latin America.

Fatores de risco e profilaxia para tromboembolismo venoso em hospitais da cidade de Manaus

“…In addition, DVT occurs in one or two of every 1,000 pregnancies. (24)(25)(26) In the present study, the stratified risk for VTE was different from that of two other studies carried out in Brazil, (21,22) in which the prevalence of the different categories of risk of developing VTE was found to be, respectively, as follows: 52.43% and 39.91% for low risk; 42.87% and 30.70% for moderate risk; and 4.70% and 29.39% for high risk.…”

“…(1,21,22) Patients over 40 years of age are Risk factors and prophylaxis for venous thromboembolism in hospitals in the city of Manaus, Brazil 119 770 (73.3%) in which no nonpharmacological prophylaxis was used (Table 5). Nonpharmacological prophylaxis consists of simple measures, such as walking, and should be used in all patients, even those at low-risk.…”

Efeito da implementação de diretriz para profilaxia de tromboembolismo venoso em pacientes cirúrgicos

“…Considering the frequency of use of post-operative prophylaxis, it was used at higher rates at HSL than at most Brazilian hospitals in previous studies. 23,24,[27][28][29][30] Graduated elastic compression stockings and intermittent pneumatic compression devices were used at higher rates at HSL than at other Brazilian institutions, [27][28][29][30][31] possibly due to the higher socioeconomic status of patients. As for frequency of use of adequate prophylaxis, considering the protocols used as reference, our data are similar to those from other centers where studies of this type were performed, both in Brazil and abroad, reaching 62.5 percent of patients treated with prophylaxis (40 percent of total patients) for orthopedic surgery and 48 percent of patients (28 percent of total) for abdominal surgery.…”

“…21,22 Various protocols seeking to classify patients according to VTE risk, doctors' warnings, and prophylaxis guidelines have been put forward, both to collect data and to standardize hospital behavior. [22][23][24][25][26][27] In 2004, a Multidisciplinary and Multiprofessional Commission was established at Hospital Sírio-Libanês (HSL), São Paulo, to develop a standard guideline for acute deep vein thrombosis and pulmonary thromboembolism prophylaxis in adult patients hospitalized for surgical or clinical care, based on controlled clinical assays, reviews, and the latest consensus of Brazilian and international literature. To that purpose, the literature from the databases MEDLINE, LILACS, the Brazilian Cochrane Center, and Brazilian and international government institutions was reviewed, using standardized search strategies to select articles relevant for the protocol.…”

Impacto de um programa para profilaxia de tromboembolismo venoso em pacientes clínicos em quatro hospitais de Salvador

“…14 Em um registro brasileiro incluindo dados de mais de 27.000 pacientes cirúrgicos e clínicos, os autores mostraram que houve subutilização de profilaxia em 25% dos pacientes com alto risco e em 45% daqueles com risco moderado de TEV, sendo que a inadequação predominou entre os pacientes clínicos. 15 Dificuldades com os métodos de avaliação de risco e várias outras barreiras pertinentes aos médicos e ao sistema de saúde fazem com que medidas efetivamente comprovadas e recomendadas em diretrizes demorem a ser aplicadas de maneira mais disseminada para benefício dos pacientes. Assim, o objetivo deste estudo foi o de avaliar o impacto da implementação de um programa de incentivo à profilaxia do TEV, baseado nas recomendações da Diretriz Brasileira para Profilaxia de TEV em Pacientes Clínicos, do Programa Diretrizes da Associação Médica Brasileira.…”