Fast track — ArticlesVenous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study
Introduction
Venous thromboembolism (VTE) is a common complication during and after hospitalisation for acute medical illness or surgery. Pulmonary embolism accounts for 5–10% of deaths in hospitalised patients, making VTE the most common preventable cause of in-hospital death.1, 2, 3, 4 In addition to the acute risk of mortality, VTE is associated with long-term risks of post-thrombotic syndrome5 and chronic thromboembolic pulmonary hypertension.6 These complications contribute substantially to patient morbidity and the cost of management.
Evidence-based consensus guidelines for VTE prophylaxis have been available for more than 15 years.7 Despite the existence of these guidelines, VTE prophylaxis remains underused.8, 9 Existing studies have assessed compliance with prophylaxis guidelines within defined institutions or countries,8, 10, 11, 12 but to date, the proportion of at-risk patients who should receive prophylaxis globally remains unknown.
We did the multinational, observational, cross-sectional Epidemiologic International Day for the Evaluation of Patients at Risk for Venous Thromboembolism in the Acute Hospital Care Setting (ENDORSE) study, a chart audit of medical and surgical patients in a large sample of hospitals worldwide. The study was designed to assess the number of patients at risk for VTE in the acute care hospital setting and to determine the proportion of these at-risk patients who received prophylaxis as recommended by the American College of Chest Physicians (ACCP) evidence-based consensus guidelines.1
Section snippets
Procedures
Hospitals were considered eligible for enrolment if they contained more than 50 beds, admitted patients for the treatment of medical illnesses and exacerbations of chronic diseases, and scheduled routine major surgical procedures. Non-acute and single specialty hospitals were excluded.
Hospitals were selected at random from authoritative lists of acute care hospitals in 32 participating countries. In the USA, a list of acute care hospitals from the American Hospital Association was used.13 The
Results
Between August, 2006, and January, 2007, eligible patients were enrolled from 358 hospitals across 32 countries that had completed the study within specified deadlines (Algeria, Australia, Bangladesh, Brazil, Bulgaria, Colombia, Czech Republic, Egypt, France, Germany, Greece, Hungary, India, Ireland, Kuwait, Mexico, Pakistan, Poland, Portugal, Romania, Russia, Saudi Arabia, Slovakia, Spain, Switzerland, Thailand, Tunisia, Turkey, United Arab Emirates, UK, USA, and Venezuela) in six continents.
Discussion
The data gathered show that, worldwide, more than half of all hospitalised patients are at risk for VTE, and that surgical patients seem to be at higher risk than are medical patients. Furthermore, only half of at-risk patients received an ACCP-recommended method of prophylaxis. Previous studies have reported overall VTE prophylaxis rates ranging from 13% to 64%.8, 9, 10, 11, 12 This variability is largely due to individual studies limiting their assessment to predefined populations (eg,
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