Venous thromboembolism risk and prophylaxis prescription in surgical patients at a tertiary hospital in Eastern Cape Province, South Africa

Abstract

Background. Venous thromboembolism (VTE) is a common complication during and after hospitalisation, and is regarded as the most common cause of preventable death in hospitalised patients worldwide. Despite its importance, there are few data on VTE risk and adherence to prophylaxis prescription guidelines in surgical patients from the South African (SA) public sector, especially from lowresource environments such as Eastern Cape Province. Objectives. To evaluate the risk and prescription of VTE prophylaxis to surgical patients at a tertiary government hospital in the Eastern Cape. Methods. A cross-sectional clinical audit of general surgical inpatients was performed on two dates during July and August 2017. Patients' VTE risk was calculated by using the Caprini risk assessment model (RAM) and thromboprophylaxis prescription evaluated accordingly. Results. A total of 179 patients were included in the study, of whom 56% were male and 44% female. The average age was 45 (range 18 -83) years. Of the total number of participants, 33% were elective cases and 67% were emergency admissions. With application of RAM, 77% of patients were at risk of VTE (Caprini score ≥2), with 81% of elective and 74% of emergency patients being at risk. The most prevalent risk factors for VTE were major surgery (34%), age 41 -60 years (30%), age 61 -74 years (20%) and sepsis during the previous month (27%). A contraindication to chemoprophylaxis was recorded in 30% of patients, with the most prevalent being renal dysfunction (40%), peptic ulcer disease (34%), active bleeding (17%), liver dysfunction (17%), coagulopathy (6%) and recent cerebral haemorrhage (6%). With regard to VTE risk profile and contraindications to chemoprophylaxis, the correct thromboprophylactic treatment was prescribed to 26% of at-risk patients, with 21% of elective and 27% of emergency admission patients receiving the correct therapy. Conclusions. Despite a high proportion of patients being at risk of VTE, the rate of adequate thromboprophylaxis prescription for surgical inpatients at Frere Hospital, East London, SA is very low. Increased availability of mechanical prophylaxis, as well as interventions to improve the rate of adequate prophylaxis prescription, needs to be evaluated for feasibility and effect in this hospital and other SA public hospitals.

Incomplete vaccination and associated factors among children aged 12–23 months in South Africa: an analysis of the South African demographic and health survey 2016

“…The ongoing national vaccination survey, the first of its kind since 1994, provides an opportunity for collecting more accurate and nationally representative data. 44 Secondly, the findings of the present study underscore the need to conduct research aimed at unraveling the contextual determinants of poor childhood vaccination uptake at multiple levels and perspectives. This is important to unmask the contextual enablers of geographical disparities in vaccination access, as highlighted by our study.…”

Venous thromboembolism risk assessment and prophylaxis in hospitalised medical patients in the Cape Town metropole, South Africa

“…[3] The therapeutic practice guideline for VTE developed by the Southern African Society of Thrombosis and Haemostasis closely mirrors the ACCP guideline, which bases VTE risk assessment on the Caprini RAM. [2,9] SA has one of the greatest dual burdens of tuberculosis (TB) and HIV infection globally, and both infections have well-established relationships with VTE development. [7] In SA, TB was reported to be the leading cause of death in 2017, and disruptions in TB-related care due to the COVID-19 pandemic have been reported.…”

“…PE as a complication of VTE is the most preventable cause of inpatient death across the globe. [1,2] VTE is linked to increased healthcare costs, intensive care unit admission and longer hospital stay. [3] Findings from the multinational ENDORSE (Epidemiologic International Day for the Evaluation of Patients at Risk for Venous Thromboembolism in the Acute Hospital Care Setting) study revealed that more than half of all hospitalised patients were at risk for VTE, and 41.5% of these were medical inpatients.…”

“…[6,7] This lack of data extends across both the private and public healthcare sectors. [2,3] The SA-based TUNE-IN (The Use of VTE prophylaxis in relatioN to patiEnt risk profiling) study aimed to assess VTE prophylaxis use in hospitalised patients in relation to their risk profile. The authors reported a 67.1% risk of VTE in medical inpatients admitted to private healthcare sector hospitals across Gauteng Province, SA.…”

“…[3,9] The Caprini RAM offers a simple and comprehensive approach to VTE risk assessment in both surgical and medical inpatients. [1][2][3] Furthermore, it has undergone several modifications since its introduction in 1991 and has been validated in >250 000 patients in >100 trials worldwide. [1] Development of the Caprini RAM was based on the implementation of the American College of Chest Physicians (ACCP) thromboprophylaxis guideline, one of the leading VTE prophylaxis This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.…”