Thromboprophylaxis and mortality among patients who developed venous thromboembolism in seven major hospitals in Saudi Arabia

Fahad M Al-Hameed; Hasan M Al-Dorzi; Abdulelah I Qadhi; Amira Shaker; Farjah H Al-Gahtani; Fawzi F Al-Jassir; Galila F Zahir; Tarig S Al-Khuwaitir; Mohammed H Addar; Mohamed S Al-Hajjaj; Mohamed A Abdelaal; Essam Y Aboelnazar

doi:10.4103/atm.ATM_101_17

Official publication of the Saudi Thoracic Society, affiliated to King Saud University

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ORIGINAL ARTICLE

Year : 2017 | Volume : 12 | Issue : 4 | Page : 282-289

Thromboprophylaxis and mortality among patients who developed venous thromboembolism in seven major hospitals in Saudi Arabia

Fahad M Al-Hameed¹, Hasan M Al-Dorzi², Abdulelah I Qadhi³, Amira Shaker⁴, Farjah H Al-Gahtani⁵, Fawzi F Al-Jassir⁶, Galila F Zahir⁷, Tarig S Al-Khuwaitir⁸, Mohammed H Addar⁹, Mohamed S Al-Hajjaj¹⁰, Mohamed A Abdelaal¹¹, Essam Y Aboelnazar¹²
¹ Department of Intensive Care, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, Saudi Arabia
² Department of Intensive Care, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia
³ Department of Medicine, King Fahad General Hospital, MOH, Jeddah, Saudi Arabia
⁴ Department of Medicine, Prince Sultan Military Hospital, Riyadh, Saudi Arabia
⁵ Department of Hematology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
⁶ Department of Orthopedics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
⁷ Department of Hematology, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
⁸ Department of Medicine, King Saud Medical City, MOH, Riyadh, Saudi Arabia
⁹ Department of Obstetrics and Gynecology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
¹⁰ Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
¹¹ Department of Pathology, King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, Saudi Arabia
¹² Department of Surgery, Um Al-Qura University, Makkah, Saudi Arabia

Correspondence Address:
Fahad M Al-Hameed
Department of Intensive Care, College of Medicine, King Saud bin Abdul-Aziz University for Health Sciences, King Abdulaziz Medical City, National Guard Health Affairs, Jeddah
Saudi Arabia

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/atm.ATM_101_17

Introduction: Venous thromboembolism (VTE) during hospitalization is a serious and potentially fatal condition. Despite its effectiveness, evidence-based thromboprophylaxis is still underutilized in many countries including Saudi Arabia. Objective of the Study: Our objectives were to determine how often hospital-acquired VTE patients received appropriate thromboprophylaxis, VTE-associated mortality, and the percentage of patients given anticoagulant therapy and adherence to it after discharged. Methods: This study was conducted in seven major hospitals in Saudi Arabia. From July 1, 2009, till June 30, 2010, all recorded deep vein thrombosis (DVT) and pulmonary embolism (PE) cases were noted. Only patients with confirmed VTE diagnosis were included in the analysis. Results: A total of 1241 confirmed VTE cases occurred during the 12-month period. Most (58.3%) of them were DVT only, 21.7% were PE, and 20% were both DVT and PE. 21.4% and 78.6% of confirmed VTE occurred in surgical and medical patients, respectively. Only 40.9% of VTE cases received appropriate prophylaxis (63.2% for surgical patients and 34.8% for medical patients; P < 0.001). The mortality rate was 14.3% which represented 1.6% of total hospital deaths. Mortality was 13.5% for surgical patients and 14.5% for medical patients (P > 0.05). Appropriate thromboprophylaxis was associated with 4.11% absolute risk reduction in mortality (95% confidence interval: 0.24%–7.97%). Most (89.4%) of the survived patients received anticoagulation therapy at discharge and 71.7% of them were adherent to it on follow-up. Conclusion: Thromboprophylaxis was underutilized in major Saudi hospitals denoting a gap between guideline and practice. This gap was more marked in medical than surgical patients. Hospital-acquired VTE was associated with significant mortality. Efforts to improve thromboprophylaxis utilization are warranted.

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