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AL-Mugheed K, Bayraktar N, Nashwan AJ, Al-Bsheish M, AlSyouf A, Jarrar M. Compliance of non-pharmacological preventive practice of venous thromboembolism among Jordanian nurses. Medicine (Baltimore) 2022; 101:e31189. [PMID: 36343046 PMCID: PMC9646611 DOI: 10.1097/md.0000000000031189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Many practices, such as non-pharmacological preventive practices, have demonstrated significant improvement and reduced the venous thromboembolism incidence. This study aims at investigating the compliance with non-pharmacological preventive practice of venous thromboembolism guidelines among Jordanian intensive care and medical and surgical nurses. Descriptive and cross-sectional with the non-participant observational design was used. This study recruited 271 registered nurses in adult medical-surgical units and intensive care units of 12 different government hospitals in Jordan's middle and north regions. The observational checklist included 10 preventive practices based on the non-pharmacological preventive of venous thromboembolism guidelines. In the observational checklist, the highest score was 20, and the lowest was 0. If the nurse received equal to or higher than (>14) score were classified as sufficient compliance, while insufficient compliance was (≤14) score. The observations period started from September 2019 until March 2020. The participants' overall mean venous thromboembolism compliance score was insufficient compliance (10.6 ± 1.6). The majority of nurses were classified as insufficient compliance 67%. "Doing foot exercise and early ambulation 2 times per day 50.3%" and "checked the integrity of the patient's skin at regular intervals 50.0%" were the highest practices done rightly and completely by half of the participants. The participants who had a bachelor of nursing degree, staff nurse, and works in the intensive care unit, are less experienced and have no previous venous thromboembolism education reported low venous thromboembolism compliance. This study presents expanded compliance regarding venous thromboembolism preventive practices among Jordanian intensive care and medical & surgical nurses, so the policymakers need to develop an initiative to improve nurses' compliance.
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Affiliation(s)
- Khaild AL-Mugheed
- Nursing Department, AL-Ghad International College for Applied Medical Sciences, Jeddah, Saudi Arabia
- * Correspondence: Abdulqadir J. Nashwan, Nursing Department, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar (e-mail: ), Khaild AL-Mugheed, Nursing Department, AL-Ghad International College for Applied Medical Sciences, Jeddah, Saudi Arabia (e-mail: )
| | - Nurhan Bayraktar
- Atilim University School of Health Sciences, Nursing Department Kizilcasar Mahallesi, Turkey
| | - Abdulqadir J. Nashwan
- Atilim University School of Health Sciences, Nursing Department Kizilcasar Mahallesi, Turkey
- * Correspondence: Abdulqadir J. Nashwan, Nursing Department, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar (e-mail: ), Khaild AL-Mugheed, Nursing Department, AL-Ghad International College for Applied Medical Sciences, Jeddah, Saudi Arabia (e-mail: )
| | - Mohammad Al-Bsheish
- Health Management Department, Batterjee Medical College, Jeddah, Saudi Arabia
- Al-Nadeem Governmental Hospital, Ministry of Health, Amman, Jordan
| | - Adi AlSyouf
- Medical Education Department, King Fahd Hospital of the University, Al-Khobar 34445, Saudi Arabia
| | - Mu’taman Jarrar
- Medical Education Department, King Fahd Hospital of the University, Al-Khobar 34445, Saudi Arabia
- Vice Deanship for Development and Community Partnership, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
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A cross-sectional, multicenter, observational study to assess the prophylaxis of venous thromboembolism in Lebanese and Jordanian hospitals. Thromb J 2021; 19:9. [PMID: 33568129 PMCID: PMC7877011 DOI: 10.1186/s12959-021-00261-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 02/01/2021] [Indexed: 12/03/2022] Open
Abstract
Background There is a growing body of evidence showing substantial underuse of appropriate venous thromboembolism (VTE) prophylaxis in patients at risk. In the present study, our goal was to assess the current practices in the use rate of VTE prophylaxis among hospitalized patients in Jordan and Lebanon. Methods A cross-sectional, multicenter, observational study was conducted on 40 centers across Lebanon and Jordan. We included patients who were admitted to the participating hospitals for the treatment of a serious medical or surgical illness. The patients’ records were screened for the fulfillment of inclusion/exclusion criteria during a single assessment visit. The proportion of medical and surgical patients who were at risk of VTE and the thrombo-prophylactic measures employed by physicians for these patients were assessed according to the American College of Chest Physicians (ACCP 2016) guidelines. Results The present study included 704 patients (400 from Jordan and 304 from Lebanon) with a mean age of 54.9 ± 17.5 years. Almost 59% of the patients received prophylaxis treatment in form of pharmacological anticoagulant prophylaxis and/or mechanical prophylaxis. Low molecular weight heparin was the most commonly used anticoagulant for VTE prophylaxis in 366 out of the total 704 (51.9%) patients in the analysis cohort. Two hundred and sixteen patients (52, 95% confidence interval [47.1–56.9%]) received appropriate prophylactic agents out of 415 patients who were eligible for prophylaxis according to the ACCP 2016 guidelines. On the other hand, 199 (72.1, 95% confidence interval [66.4–77.3%) patients received prophylaxis out of 276 ineligible patients. The rate of compliance to guidelines showed wide variations according to the type of hospital, specialty, and the patients’ age. The multivariate logistic regression analysis showed that only age was a significant predictor of appropriate VTE prophylaxis (odds ratio [OR] 1.05, P < 0.001). Conclusion The rates of the appropriate use of VTE prophylaxis are low in Lebanon and Jordan. There is a lack of compliance to guidelines for VTE prophylaxis use for hospitalized patients in both countries. Supplementary Information The online version contains supplementary material available at 10.1186/s12959-021-00261-2.
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Raymundo SRDO, Lobo SMA, Hussain KMK, Hussein KG, Secches IT. What has changed in venous thromboembolism prophylaxis for hospitalized patients over recent decades: review article. J Vasc Bras 2019; 18:e20180021. [PMID: 31191626 PMCID: PMC6542320 DOI: 10.1590/1677-5449.002118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 11/13/2018] [Indexed: 11/21/2022] Open
Abstract
Venous thromboembolism (VTE) is a common disease with high rates of morbidity and mortality and is considered the number one cause of avoidable mortality among hospitalized patients. Although VTE incidence is extremely high in all countries and there is ample evidence that thromboprophylaxis inexpensively reduces the rate of thromboembolic complications in both clinical and surgical patients, a great deal of doubt remains with respect to patient safety with this type of intervention and in relation to the ideal thromboprophylaxis methods. Countless studies and evidence-based recommendations confirm the efficacy of prophylaxis for prevention of VTE and/or patient deaths, but it remains underutilized to this day. This article presents a wide-ranging review of existing prophylaxis methods up to the present, from guidelines and national and international studies of thromboprophylaxis.
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Affiliation(s)
- Selma Regina de Oliveira Raymundo
- Faculdade Regional de Medicina de São José do Rio Preto - FAMERP, Hospital de Base, São José do Rio Preto, SP, Brasil.,Hospital Austa, São José do Rio Preto, SP, Brasil
| | - Suzana Margareth Ajeje Lobo
- Faculdade Regional de Medicina de São José do Rio Preto - FAMERP, Hospital de Base, São José do Rio Preto, SP, Brasil
| | | | - Kassim Guzzon Hussein
- Faculdade de Medicina em São José do Rio Preto - FACERES, São José do Rio Preto, SP, Brasil
| | - Isabela Tobal Secches
- Faculdade de Medicina em São José do Rio Preto - FACERES, São José do Rio Preto, SP, Brasil
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Tazi Mezalek Z, Nejjari C, Essadouni L, Samkaoui M, Serraj K, Ammouri W, Kanjaa N, Belkhadir Z, Housni B, Awab M, Faroudy M, Bono W, Kabbaj S, Akkaoui M, Barakat M, Rifai R, Charaf H, Aziz A, Elachhab Y, Azzouzi A. Evaluation and management of thromboprophylaxis in Moroccan hospitals at national level: the Avail-MoNa study. J Thromb Thrombolysis 2018; 46:113-119. [PMID: 29651665 DOI: 10.1007/s11239-018-1657-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Venous thromboembolism (VTE) is a common clinical problem that is associated with substantial morbidity and mortality. The aim of this study was to describe the clinical practices in VTE prophylaxis in university and peripheral hospitals in Morocco. This is a national, cross-sectional, multicenter, observational study assessing the management of the VTE risk in selected Moroccan hospitals (four university and three peripheral). The thromboembolic risk of the selected patients was assessed according to the American College of Chest Physicians (ACCP) guidelines (2008). We hypothesized that interventions for VTE guideline implementation in those hospitals may improve prophylaxis use for hospitalized patients. A total of 1318 patients were analyzed: 467 (35.5%) medical and 851 (64.5%) surgical. The mean age of patients was 52.6 ± 16.5 years, and 52.7% were female. A total of 51.1% patients were considered to be at risk of VTE according to ACCP guidelines and were eligible for thromboprophylaxis (TP). Medical patients were more likely to present risk factors than surgical patients (53.6 vs. 50.7%, respectively). TP was prescribed for 53.1% of these patients, 57.4% in at-risk surgical patients and 50.3% in at-risk medical patients. TP was also prescribed for 42.9% of non-at-risk patients. The concordance between the recommended and the prescribed prophylaxis was poor for the total population (kappa = 0.110). TP did not improve sufficiently in our hospitals, even after implementation of the guidelines. New strategies are required to appropriately address TP in hospitalized patients.
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Affiliation(s)
- Z Tazi Mezalek
- Department of Internal Medicine/Hematology, Ibn Sina University Hospital, Rabat, Morocco. .,Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco.
| | - C Nejjari
- Laboratory of Epidemiology, Clinical Research and Community Health Faculty of Medicine and Pharmacy, Fez, Morocco
| | - L Essadouni
- Internal Medicine Department, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital, Cadi Ayyad University, Marrakech, Morocco
| | - M Samkaoui
- Department of Anesthesia, Emergency and Intensive Care Medicine, Faculty of Medicine and Pharmacy, Mohammed VI Hospital, Cadi Ayyad University, Marrakech, Morocco
| | - K Serraj
- Internal Medicine Department, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital, University Mohammed VI, Oujda, Morocco
| | - W Ammouri
- Department of Internal Medicine/Hematology, Ibn Sina University Hospital, Rabat, Morocco.,Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - N Kanjaa
- Department of Anesthesia Reanimation, Faculty of Medicine and Pharmacy, Hassan II University Hospital, Fez, Morocco
| | - Z Belkhadir
- Pole of Anesthesia and Intensive Care, Palliative Care Unit, National Institute of Oncology, Rabat, Morocco
| | - B Housni
- Anesthesia Reanimation Department, Mohammed VI University Hospital, Oujda, Morocco
| | - M Awab
- Anesthesia Reanimation Department, Ibn Sina University Hospital, Rabat, Morocco
| | - M Faroudy
- Anesthesia Reanimation- Trauma Unit, Ibn Sina University Hospital, Rabat, Morocco
| | - W Bono
- Internal Medicine Department, Hassan II University Hospital, Fez, Morocco
| | - S Kabbaj
- Anesthesia Reanimation Department, Specialty Hospital, Rabat, Morocco
| | - M Akkaoui
- Anesthesia Reanimation, Mohammed V Hospital, Meknes, Morocco
| | - M Barakat
- Anesthesia Reanimation, Mohammed V Hospital, Tangier, Morocco
| | - R Rifai
- Traumatology Orthopedics, Mohammed V Hospital, Meknes, Morocco
| | - H Charaf
- Anesthesia Reanimation, Mohammed V Hospital, Casablanca, Morocco
| | - A Aziz
- Traumatology Orthopedics, Mohammed V Hospital, Casablanca, Morocco
| | - Y Elachhab
- Laboratory of Epidemiology, Clinical Research and Community Health Faculty of Medicine and Pharmacy, Fez, Morocco
| | - A Azzouzi
- Anesthesia Reanimation Department, Ibn Sina University Hospital, Rabat, Morocco
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Evaluation of venous thromboembolism prophylaxis in a major hospital in a developing country. Int J Clin Pharm 2017. [DOI: 10.1007/s11096-017-0494-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Gerotziafas GT, Taher A, Abdel-Razeq H, AboElnazar E, Spyropoulos AC, El Shemmari S, Larsen AK, Elalamy I. A Predictive Score for Thrombosis Associated with Breast, Colorectal, Lung, or Ovarian Cancer: The Prospective COMPASS-Cancer-Associated Thrombosis Study. Oncologist 2017; 22:1222-1231. [PMID: 28550032 PMCID: PMC5634762 DOI: 10.1634/theoncologist.2016-0414] [Citation(s) in RCA: 145] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 03/08/2017] [Indexed: 12/21/2022] Open
Abstract
The COMPASS‐CAT study was undertaken in outpatients with breast, colon, lung, or ovarian cancer. The aim of the study was to identify the most relevat risk factors for symptomatic thromboembolism and to develop a risk assessment model applicable to patients after the initiation of anticancer treatment. Background. The stratification of outpatients on chemotherapy for breast, colorectal, lung, and ovarian cancers at risk of venous thromboembolism (VTE) remains an unmet clinical need. The derivation of a risk assessment model (RAM) for VTE in these patients was the aim of the study “Prospective Comparison of Methods for thromboembolic risk assessment with clinical Perceptions and AwareneSS in real life patients–Cancer Associated Thrombosis” (COMPASS–CAT). Patients and Methods. The derivation cohort consisted of 1,023 outpatients. Patients on low molecular weight heparin (LMWH) thromboprophylaxis were excluded. Documented symptomatic VTE was the endpoint of the study. Results. Patients had breast (61%), colorectal (17%), lung (13%), or ovarian cancer (8.6%) at localized (30%) or advanced stage (70%). In 64% of patients, cancer was diagnosed within the last 6 months prior to inclusion. Most of them were on chemotherapy when assessed. Symptomatic VTE occurred in 8.5% of patients. The COMPASS–CAT RAM includes the following variables: (a) anthracycline or anti‐hormonal therapy, (b) time since cancer diagnosis, (c) central venous catheter, (d) stage of cancer, (e) presence of cardiovascular risk factors, (f) recent hospitalization for acute medical illness, (g) personal history of VTE, and (h) platelet count. At 6 months, patients stratified at low/intermediate and high‐risk groups had VTE rates of 1.7% and 13.3%, respectively. The area under the curve of receiver operating characteristics analysis was 0.85. The sensitivity and specificity of the RAM were 88% and 52%, respectively. The negative and positive predictive values of the RAM were 98% and 13%, respectively. Conclusion. The COMPASS–CAT RAM includes reliable and easily collected VTE risk predictors and, in contrast to the Khorana score, it is applicable after the initiation of anticancer treatment in patients with common solid tumors. Its robustness for stratification of patients at high and low/intermediate VTE risk needs to be externally validated. Implications for Practice. The Prospective Comparison of Methods for thromboembolic risk assessment with clinical Perceptions and AwareneSS in real life patients–Cancer Associated Thrombosis (COMPASS–CAT) study provides a new risk assessment model (RAM) for venous thromboembolism (VTE) applicable in outpatients with breast, colorectal, lung or ovarian cancer. The COMPASS–CAT RAM is robust, applicable during chemotherapy and determines the need for VTE prévention by including reliable and easily collected VTE predictors associated with cancer status, its treatment as well as with patients' characteristics and comorbidities. An independent external validation of the RAM is indicated before its use in clinical practice.
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Affiliation(s)
- Grigoris T Gerotziafas
- Cancer Biology and Therapeutics, INSERM U938, Institut Universitaire de Cancérologie (IUC), Faculté de Médecine Pierre et Marie Curie, Université Pierre et Marie Curie (UPMC), Sorbonne Universités, Paris, France
- Service d'Hématologie Biologique Hôpital Tenon, Hôpitaux Universitaires Est Parisien, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Ali Taher
- Department of Internal Medicine, Division of Hematology/Oncology, American University of Beirut, Lebanon
| | - Hikmat Abdel-Razeq
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | | | - Alex C Spyropoulos
- Department of Medicine, Anticoagulation and Clinical Thrombosis Services, Hofstra Northwell School of Medicine, Northwell Health System, Manhasset, New York, USA
| | - Salem El Shemmari
- Department of Medical Oncology, Kuwait Cancer Control Center, Kuwait City, Kuwait
| | - Annette K Larsen
- Cancer Biology and Therapeutics, INSERM U938, Institut Universitaire de Cancérologie (IUC), Faculté de Médecine Pierre et Marie Curie, Université Pierre et Marie Curie (UPMC), Sorbonne Universités, Paris, France
| | - Ismail Elalamy
- Cancer Biology and Therapeutics, INSERM U938, Institut Universitaire de Cancérologie (IUC), Faculté de Médecine Pierre et Marie Curie, Université Pierre et Marie Curie (UPMC), Sorbonne Universités, Paris, France
- Service d'Hématologie Biologique Hôpital Tenon, Hôpitaux Universitaires Est Parisien, Assistance Publique Hôpitaux de Paris, Paris, France
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Gharaibeh L, Younes N, Albsoul-Younes A. Role of the clinical pharmacist in improving the appropriateness of venous thromboembolism prophylaxis in hospitalised patients in Jordan. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2017. [DOI: 10.1002/jppr.1230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Lubna Gharaibeh
- Faculty of Pharmacy; Department of Biopharmaceutics and Clinical Pharmacy; University of Jordan; Amman Jordan
| | - Nidal Younes
- Faculty of Medicine; Department of General Surgery; University of Jordan; Amman Jordan
| | - Abla Albsoul-Younes
- Faculty of Pharmacy; Department of Biopharmaceutics and Clinical Pharmacy; University of Jordan; Amman Jordan
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Geahchan N, Basile M, Tohmeh M. Venous thromboembolism prophylaxis in patients undergoing abdominal and pelvic cancer surgery: adherence and compliance to ACCP guidelines in DIONYS registry. SPRINGERPLUS 2016; 5:1541. [PMID: 27652114 PMCID: PMC5020030 DOI: 10.1186/s40064-016-3057-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 05/30/2016] [Indexed: 11/14/2022]
Abstract
BACKGROUND Venous thromboembolism (VTE) is a major health care problem resulting in significant mortality, morbidity and increase in medical expenses. Patients with malignant diseases represent a high risk population for VTE. The American College of Chest Physicians (ACCP) proposed, since 1986, prophylaxis guidelines that are unequally respected in surgical practice. METHODS DIONYS is a multinational, longitudinal and non-interventional registry including patients having undergone abdominal or pelvic surgery for cancer in Latin America, Africa and the Middle East. Patients were evaluated with regard to VTE prophylaxis, during three consecutive visits, for their adherence to ACCP 2008 guidelines. Data were collected on type and duration of VTE prophylaxis, adherence to guidelines, and compliance with prescriptions, complications and possible reasons for omission of prophylaxis. RESULTS Between 2011 and June 2012, 921 adult patients were included and divided into abdominal (435), pelvic (390) and combined abdominal and pelvic surgery (96), 65.4 % being females. VTE prophylaxis was prescribed to 90 % of patients during hospitalization and to 28.3 % after hospital discharge. Prescriptions adhered to ACCP guidelines in 73.9 % of patients during hospitalization and 18.9 % after discharge. The reason of non-adherence was mainly the clinical judgment by the physician that the patient did not need a prophylaxis. The most commonly prescribed type of prophylaxis was pharmacological (low molecular weight heparin). CONCLUSION A wide gap exists between VTE prophylaxis in daily practice and the ACCP 2008 guidelines, in abdominal and pelvic cancer surgery. A better awareness of surgeons is probably the best guarantee for improvement of VTE prophylaxis in surgical wards.
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Affiliation(s)
- Negib Geahchan
- Faculty of Medicine, Saint Joseph University, Damascus street, Riad El Solh, P.O.Box 11-5076, Beirut, 1107 2180 Lebanon
| | - Melkart Basile
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Maroon Tohmeh
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - on behalf of the DIONYS registry
- Faculty of Medicine, Saint Joseph University, Damascus street, Riad El Solh, P.O.Box 11-5076, Beirut, 1107 2180 Lebanon
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
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Khademvatani K, Seyyed-Mohammadzad MH, Akbari M, Rezaei Y, Eskandari R, Rostamzadeh A. The relationship between vitamin D status and idiopathic lower-extremity deep vein thrombosis. Int J Gen Med 2014; 7:303-9. [PMID: 24971035 PMCID: PMC4069050 DOI: 10.2147/ijgm.s64812] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Vitamin D has been shown to have an anticoagulant effect. A decrease in 25-hydroxyvitamin D [25(OH)D] concentration has also been associated with an increased risk of venous thromboembolism. Hence, we sought to determine the relationship between 25(OH) D levels and idiopathic lower-extremity deep vein thrombosis (DVT). Methods In a case control study, a total of 82 participants with idiopathic lower-extremity DVT were enrolled along with 85 sex- and age-matched healthy participants as controls. The plasma 25(OH)D levels were measured in all the studied samples. Results The participants’ mean age was 47.1±12.3 years. Baseline characteristics were not significantly different between the groups. The concentration of 25(OH)D was significantly lower in the DVT group compared to that of the control group (17.9±10.3 versus 23.1±12.5 ng/mL, P=0.004). The prevalence of participants with deficient 25(OH)D levels was significantly higher in the both DVT and control groups than those with sufficient 25(OH)D levels (68.3% versus 13.4%, and 49.4% versus 28.2%, respectively, P=0.027). In a multivariate analysis, 25(OH)D levels and sex were found to be the only independent predictors of DVT (odds ratio [OR] 1.05, 95% confidence interval [CI] 1.02–1.08, P=0.001 and OR 0.51, 95% CI 0.26–1.00, P=0.049, respectively). Conclusion Low levels of 25(OH)D are associated with idiopathic lower-extremity DVT. Further investigation is needed to establish determinants and probable causative role of 25(OH)D.
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Affiliation(s)
- Kamal Khademvatani
- Department of Cardiology, Seyyed-al-Shohada Heart Center, Urmia University of Medical Sciences, Urmia, Iran
| | | | - Mohammad Akbari
- Department of Cardiology, Seyyed-al-Shohada Heart Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Yousef Rezaei
- Seyyed-al-Shohada Heart Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Ramin Eskandari
- Department of Cardiology, Firoozgar Hospital, Iran University of Medial Sciences, Tehran, Iran
| | - Alireza Rostamzadeh
- Department of Cardiology, Seyyed-al-Shohada Heart Center, Urmia University of Medical Sciences, Urmia, Iran
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Thromboprophylaxis use and concordance with guidelines among medical and surgical patients in Morocco. Thromb Res 2014; 133:725-8. [PMID: 24530213 DOI: 10.1016/j.thromres.2014.01.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 11/26/2013] [Accepted: 01/27/2014] [Indexed: 02/01/2023]
Abstract
INTRODUCTION No data are available on thromboprophylaxis use in Morocco. Our aim was to characterize patients at risk of venous thromboembolism and assess the rate of appropriate thromboprophylaxis. MATERIALS AND METHODS This was a national, observational, multicentre survey of venous thromboembolism risk and thromboprophylaxis use in hospitalized patients. Data were collected on a predefined date in three university hospitals in Morocco using a standardized pre-printed form. Thromboembolic risk was assessed according to the American College of Chest Physicians (ACCP) 2008 guidelines. Patients were classified as "thromboprophylaxis indicated" or "thromboprophylaxis not indicated". RESULTS 784 patients were analysed: 307 (39.2%) medical and 477 (60.8%) surgical. 421 (53.7%) were female. Medical patients were older than surgical patients (57.6 ± 11.5 vs. 46.2 ± 16.9 years, p<0.0001) and were more likely to have risk factors for thromboembolism (50.5% vs. 45.7% of patients, p=NS). 57% of patients without contraindications or bleeding risk were at risk of thromboembolism according to ACCP guidelines and thromboprophylaxis was prescribed to 42.8% of these patients. In contrast, 7.4% of patients with no thromboembolic risk also received thromboprophylaxis (proportion agreement: 61.0%; Kappa=0.296). Over half (54.5%) of medical patients at risk of thromboembolism did not receive thromboprophylaxis whereas 6.3% of those with no risk did receive it (proportion agreement: 76.4%; Kappa=0.433). These figures were 57.9% and 9.2%, respectively, for surgical patients (proportion agreement: 52.7%; Kappa=0.191). Thromboprophylaxis was given to 19.2% of patients with contraindications or a bleeding risk. CONCLUSIONS Educational initiatives are imperative to inform doctors about appropriate thromboprophylaxis.
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Mokhtari M, Attarian H, Norouzi M, Kouchek M, Kashani BS, Sirati F, Pourmirza B, Mir E. Venous thromboembolism risk assessment, prophylaxis practices and interventions for its improvement (AVAIL-ME Extension Project, Iran). Thromb Res 2014; 133:567-73. [PMID: 24507872 DOI: 10.1016/j.thromres.2014.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 12/29/2013] [Accepted: 01/06/2014] [Indexed: 01/29/2023]
Abstract
BACKGROUND Venous thromboembolism (VTE) is a major health issue worldwide. Data about VTE prophylaxis practices in developing countries are scarce. OBJECTIVES The primary objectives of this survey were to define the VTE risk factors in hospitalized patients, to determine the rates of VTE prophylaxis administration and guideline compliance and to assess the effects of an educational program on VTE prophylaxis practices in Iran. PATIENTS AND METHODS Data on 1219 patients from twenty hospitals in Iran were extracted from the AVAIL-ME Extension project main databank. VTE risks were categorized according to the Caprini Risk Assessment Model. Logistic regression analysis was carried out to assess factors influencing VTE prophylaxis. We also examined the impact of an educational program which consisted of awareness, risk assessment, internal protocol implementation and re-assessment, on VTE prophylaxis practices. RESULTS Of 1219 patients, 789 (65%) and 430 (35%) were surgical and medical, respectively. VTE risks, categorized in low, moderate, high and very high were detected in 14%, 17%, 26% and 43% of patients respectively with a total of 1042(85%) patients being at risk for VTE. Of 882 (85%) eligible patients for VTE prophylaxis, 737 (83.5%) received any drug prophylaxis of whom 265 (62%) were medical and 472 (60%) were surgical. ACCP guidelines compliance was 60% and 33% in surgical and medical patients respectively. Any VTE prevention, drug prophylaxis, mechanical prophylaxis and guideline adherence were, 48% vs. 64%, 45% vs. 60%, 6% vs. 9% and 34% vs. 45% respectively (p<00.1) before and after implementation of the VTE educational program. CONCLUSIONS Despite an overall improvement in VTE prevention, areas such as inappropriate use of VTE prophylaxis in a large number of patients, significant under-use of mechanical devices and guideline adherence require closer attention. VTE awareness education is beneficial in improving VTE prophylaxis in Iran.
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Affiliation(s)
- Majid Mokhtari
- Internal Medicine, Pulmonary and Critical Care Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Hamid Attarian
- Department of Hematology, Shahid Beheshti University of Medical Sciences, Modarres Hospital, Tehran, Iran
| | - Masoud Norouzi
- Department of Orthopedic Surgery, Rasool-E-Akram Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehran Kouchek
- Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Babak Sharif Kashani
- Department of Cardiology, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Masih Daneshvari Hosp., Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | | | - Elham Mir
- Sanofi Medical Department, Tehran, Iran
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Di Nisio M, Porreca E. Prevention of venous thromboembolism in hospitalized acutely ill medical patients: focus on the clinical utility of (low-dose) fondaparinux. DRUG DESIGN DEVELOPMENT AND THERAPY 2013; 7:973-80. [PMID: 24068866 PMCID: PMC3782407 DOI: 10.2147/dddt.s38042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Venous thromboembolism (VTE) is a frequent complication among acutely ill medical patients hospitalized for congestive heart failure, acute respiratory insufficiency, rheumatologic disorders, and acute infectious and/or inflammatory diseases. Based on robust data from randomized controlled studies and meta-analyses showing a reduced incidence of VTE by 40% to about 60% with pharmacologic thromboprophylaxis, prevention of VTE with low molecular weight heparin (LMWH), unfractionated heparin (UFH), or fondaparinux is currently recommended in all at-risk hospitalized acutely ill medical patients. In patients who are bleeding or are at high risk for major bleeding, mechanical prophylaxis with graduated compression stockings or intermittent pneumatic compression may be suggested. Thromboprophylaxis is generally continued for 6 to 14 days or for the duration of hospitalization. Selected cases could benefit from extended thromboprophylaxis beyond this period, although the risk of major bleeding remains a concern, and additional studies are needed to identify patients who may benefit from prolonged prophylaxis. For hospitalized acutely ill medical patients with renal insufficiency, a low dose (1.5 mg once daily) of fondaparinux or prophylactic LMWH subcutaneously appears to have a safe profile, although proper evaluation in randomized studies is lacking. The evidence on the use of prophylaxis for VTE in this latter group of patients, as well as in those at higher risk of bleeding complications, such as patients with thrombocytopenia, remains scarce. For critically ill patients hospitalized in intensive care units with no contraindications, LMWH or UFH are recommended, with frequent and careful assessment of the risk of bleeding. In this review, we discuss the evidence for use of thromboprophylaxis for VTE in acutely ill hospitalized medical patients, with a focus on (low-dose) fondaparinux.
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Affiliation(s)
- Marcello Di Nisio
- Department of Medical, Oral and Biotechnological Sciences, University G D'Annunzio of Chieti-Pescara, via dei Vestini 31, Chieti, Italy.
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