The AVAIL ME study: a multinational survey of VTE risk and prophylaxis

Abstract

Venous thromboembolism (VTE) is a major public health issue that is frequently underestimated. The primary objective of this multinational survey was to identify patients at risk for VTE, and to define the rate of patients receiving appropriate prophylaxis in the Middle Eastern region. Standardized case report forms were filled by trained individuals on one predefined day in selected hospitals. Data were then entered and analyzed by independent biostatisticians. Risk was categorized according to American College of Chest Physicians (ACCP) guidelines, 2004. Logistic regressions were carried out to assess factors that determined VTE prophylaxis. 845 (37%) medical and 1421 (63%) surgical patients were eligible for the study. Patients were at low (4.2%), moderate (51.7%), high (9%) and very high risk (35.2%) for VTE. Any VTE prevention was given in 17.9, 41.7, 60.6 and 66.9% of respective risk categories, while ACCP guidelines were applied in 86.3, 41.1, 48.3 and 24.5% of these categories. Surgical patient type, immobility on admission, and contraceptive use were the most important drivers of VTE prophylaxis in those who were eligible to it (OR ≥ 2). Surgical patient type, immobility during hospitalization, existence of a VTE protocol and chronic heart failure were the most important drivers for VTE prophylaxis application in patients who were not eligible for it (OR ≥ 3). A concordance κ value of 0.16 was found between eligibility for VTE prophylaxis on one hand and its application in practice (P < 0.001). Risk factors for VTE and eligibility for VTE prophylaxis are common, but VTE prophylaxis and guidelines application are low.

Venous thromboembolism prophylaxis in acutely ill hospitalized medical patients. A retrospective multicenter study

“…There is some skepticism about the benefits of VTE prophylaxis especially in the elderly [2]. During the last decade, studies using either large datasets [3][4][5] or single center experiences [6,7] reported that between 30 and 74% of the acutely ill medical patients received VTE prophylaxis. In the multinational, crosssectional ENDORSE study [8] 60.5% of medical patients at risk did not receive prophylaxis according to the ACCP-2004 guidelines.…”

Evaluation of VTE Prophylaxis in an Educational Hospital

“…15 The appropriate prophylaxis according to Caprini score was 59.9%, which is double the percentage reported by the study conducted in the same institution several years ago, which was 26%. 13 These values show an improvement in the frequency of appropriate VTE prophylaxis.…”

Antithrombotic Prophylaxis in the Middle East

“…It was conducted to properly evaluate the status of anticoagulation practices in the Middle East and to serve as a foundation for attempts at quality improvement 15. The study included countries from the Middle East (Kingdom of Saudi Arabia, Lebanon, Syria, and United Arab Emirates), and from Central Asia (Georgia, Iran, and Kazakhstan) 15.…”