Advances in Clinical and Experimental Medicine
2018, vol. 27, nr 2, February, p. 237–243
Publication type: original article
Real-life use of thromboprophylaxis in patients hospitalized for pulmonary disorders: A single-center retrospective study
1 Pulmonology Ward, The John Paul II Hospital, Kraków, Poland
2 Krakow Cardiovascular Research Institute (KCRI), Poland
3 Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
4 Krakow Centre for Medical Research and Technologies, The John Paul II Hospital, Kraków, Poland
Background. Underuse of thromboprophylaxis in hospitalized medical patients is still common worldwide. Little is known about the use of thromboprophylaxis in patients with pulmonary diseases in everyday hospital practice.
Objectives. The aim of this study was to assess the use of pharmacological prophylaxis of venous thromboembolism (VTE) in real-life patients with pulmonary diseases.
Material and Methods. In this retrospective study, 2 validated scoring systems, i.e., the Padua prediction score and Caprini VTE risk assessment, were used to assess the VTE risk in 2011 patients (1133 men and 878 women), aged 18 years or more, hospitalized for pulmonary diseases (median 6 days) in a single tertiary pulmonary medical center from January to December 2014.
Results. Using the Padua prediction score, we identified 428 (21.28%) patients at a high risk for VTE, including 167 (39.01%) who received thromboprophylaxis with low-molecular-weight heparin, and 261 (60.98%) individuals at a high risk without thromboprophylaxis (p < 0.001). A total of 888 (44.16%) patients who scored 5 points or more using the Caprini VTE risk assessment were identified as subjects at a high risk for VTE, including 34.79% of patients receiving thromboprophylaxis. From among patients at a high risk for VTE, 579 (65.20%) did not receive appropriate thromboprophylaxis (p < 0.001). Underuse of thromboprophylaxis was observed more commonly among patients hospitalized for lung cancer or pneumonia (50.60% and 24.87% of patients at a high risk for VTE without prophylaxis, respectively).
Conclusion. Thromboprophylaxis is underutilized in hospitalized patients with pulmonary diseases regardless of the scoring system used. Implementation of thromboprophylaxis should be markedly improved in this patient group.
venous thromboembolism (VTE), thromboprophylaxis, pulmonary diseases, Padua prediction score, Caprini VTE risk assessment
- Kishimoto M, Lim HY, Tokuda Y, et al. Prevalence of venous thromboembolism at a teaching hospital in Okinawa, Japan. Thromb Haemost. 2005;93:876–879.
- Cohen AT, Tapson VF, Bergmann JF, et al. ENDORSE Investigators. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): A multinational cross-sectional study. Lancet. 2008;371(9610):387–394.
- Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism. American College of Chest Physicians Evidence-Based Clinical Practice Guidelines, 8th ed. Chest. 2008;133(6 Suppl):381S–453S.
- Lindblad B, Sternby NH, Bergqvist D. Incidence of venous thromboembolism verified by necropsy over 30 years. BMJ. 1991;302(6778): 709–711.
- Kakkar N, Vasishta RK. Pulmonary embolism in medical patients: An autopsy-based study. Clin Appl Thromb Hemost. 2008;14(2):159–167.
- Heriot GS, Pitman AG, Gonzales M, McKelvie P. The four horsemen: Clinicopathological correlation in 407 hospital autopsies. Intern Med J. 2010;40(9):626–632.
- Tapson VF, Decousus H, Pini M, et al. Venous thromboembolism prophylaxis in acutely ill hospitalized medical patients: Findings from the International Medical Prevention Registry on Venous Thromboembolism. Chest. 2007;123:936–945.
- Lloyd NS, Douketis JD, Moinuddin I, Lim W, Crowther MA. Anticoagulant prophylaxis to prevent asymptomatic deep vein thrombosis in hospitalized medical patients: A systematic review and meta-analysis. J Thromb Haemost. 2008;6(3):405–414.
- Kahn SR, Lim W, Dunn AS, et al. Prevention of VTE in nonsurgical patients: Antithrombotic therapy and prevention of thrombosis. American College of Chest Physicians Evidence-Based Clinical Practice Guidelines, 9th ed. Chest. 2012;141(2 Suppl):195S–226S.
- Zawilska K, Bała M, Błędowski P, et al. Polish guidelines for the prevention and treatment of venous thromboembolism – Update 2012. Pol Arch Med Wewn. 2012;122(Suppl 2):3–74.
- Barbar S, Noventa F, Rossetto V, et al. A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: the Padua prediction score. Thromb Haemost. 2010;8(11):2450–2457.
- Samama MM, Cohen AT, Darmon JY, et al. A comparison of enoxaparin with placebo for the prevention of venous thromboembolism in acutely ill medical patients: Prophylaxis in medical patients with enoxaparin study group. N Engl J Med. 1999;341(11):793–800.
- Leizorovicz A, Cohen AT, Turpie AG, Olsson CG, Vaitkus PT, Goldhaber SZ. Randomized, placebo controlled trial of dalteparin for the prevention of venous thromboembolism in acutely ill medical patients. Circulation. 2004;110(7):874–879.
- Cohen AT, Davidson BL, Gallus AS, et al. Efficacy and safety of fondaparinux for the prevention of venous thromboembolism in older acute medical patients: Randomized placebo controlled trial. BMJ. 2006;332(7537):325–329.
- Akgun M, Meral M, Onbas O, et al. Comparison of clinical characteristics and outcomes of patients with COPD exacerbation with or without venous thromboembolism. Respiration. 2006;73(4):428–433.
- Erelel M, Cuhadaroglu C, Ece T, Arseven O. The frequency of deep venous thrombosis and pulmonary embolus in acute exacerbation of chronic obstructive pulmonary disease. Respir Med. 2002;96(7): 515–518.
- Tillie-Leblond I, Mastora I, Radenne F, et al. Risk of pulmonary embolism after a negative spiral CT angiogram in patients with pulmonary disease: 1-year clinical follow-up study. Radiology. 2002;223(2):461–467.
- Mispelaere D, Glerant JC, Audebert M, Remond A, Sevestre-Pietri MA, Jounieaux V. Pulmonary embolism and sibilant types of chronic obstructive pulmonary disease decompensations. Rev Mal Respir. 2002;19(4):415–423.
- Baum GL, Fisher FD. The relationship of fatal pulmonary insufficiency with cor pulmonale, right-sided mural thrombi and pulmonary emboli: A preliminary report. Am J Med Sci. 1960;240:609–612.
- Mitchell RS, Silvers GW, Dart GA, et al. Clinical and morphologic correlations in chronic airway obstruction. Aspen Emphysema Conf. 1968;9:109–123.
- Levitan N, Dowlati A, Remick SC, et al. Rates of initial and recurrent thromboembolic disease among patients with malignancy versus those without malignancy: Risk analysis using Medicare claims data. Medicine (Baltimore). 1999;78:285–291.
- Shinagare AB, Guo M, Hatabu H, et al. Incidence of pulmonary embolism in oncologic outpatients at a tertiary cancer center. Cancer. 2011; 117(16):3860–3866.
- Chew HK, Davies AM, Wun T, et al. The incidence of venous thromboembolism among patients with primary lung cancer. J Thromb Haemost. 2008;6(4):601–608.
- Walker AJ, Baldwin DR, Card TR, Powell HA, Hubbard RB, Grainge MJ. Risk of venous thromboembolism in people with lung cancer: A cohort study using linked UK healthcare data. Br J Cancer. Epub 2016. doi: 10.1038/bjc.2016.143.
- Jemal A, Siegel R, Xu J, Ward E. Cancer statistics 2010. CA Cancer J Clin. 2010;60(5):277–300.
- Sprunger DB, Olson AL, Huie TJ, et al. Swigris pulmonary fibrosis is associated with an elevated risk of thromboembolic disease. Eur Respir J. 2012;39(1):125–132.
- Lippi G, Favaloro EJ. Allergy and venous thromboembolism: A casual or causative association. Semin Thromb Hemost. 2016;42(1):63–68.
- Chopard P, Spirk D, Beer HJ, et al. Swiss results from a global observational study of venous thromboembolism risk and prophylaxis use in the acute care hospital setting: Analysis from the ENDORSE study. Swiss Med Wkly. 2009;139:630–635.
- Musiał J, Sydor WJ, ENDORSE Investigators – Poland. Venous thromboembolism risk and prophylaxis in the acute hospital care setting: Results of the ENDORSE study in Poland. Pol Arch Med Wewn. 2008;118(10):555–561.