Venous thromboembolism, can we do better? Profile of venous thromboembolism risk and prophylaxis in a University Hospital in the State of São Paulo

Abstract Background Venous thromboembolism (VTE) is a silent and potentially lethal disease that affects a considerable proportion of hospitalized patients. It has high morbidity and mortality and is responsible for a heavy financial burden on healthcare systems. However, VTE can be prevented using prophylaxis measures that have been established in the literature. Nonetheless, in the real world, mean rates of appropriately administered VTE prophylaxis are lower than 50%. Objectives To define the epidemiological profile of patients with VTE in a University Hospital and the rate of appropriately administered VTE prophylaxis at that service and to identify measures to improve the rate. Methods A cross-sectional, observational study was conducted with data collected from the medical records of patients who met the inclusion criteria. The rates of correct VTE prophylaxis prescribed to clinical and surgical patients were compared, assessed according to guidelines published by the Brazilian Society of Angiology and Vascular Surgery (SBACV), based on VTE risk classification. Results The overall rate of correctly-prescribed VTE prophylaxis was 42.1%, while 57.9% of patients were not managed correctly in this respect. Clinical patients had a 52.9% rate of appropriate prophylaxis, while the equivalent rate for surgical patients was 37.5%. Conclusions Rates of correctly-prescribed VTE prophylaxis are still lower than they should be. Ongoing education, measures to encourage bedside risk stratification, and improvements to the electronic prescription system could increase appropriate VTE prophylaxis rates.

背景：静脉血栓栓塞症（Venous thromboembolism, VTE）是一种隐匿性且具有潜在致死性的疾病，累及相当比例的住院患者。该病具有较高的发病率与病死率，给医疗体系带来沉重的经济负担。现有文献已确立VTE的预防措施，可实现有效防控。然而在真实临床场景中，规范实施VTE预防的平均比例仍不足50%。

研究目的：明确某大学医院VTE患者的流行病学特征，以及该医疗机构内规范VTE预防的实施比例，并探寻提升该预防比例的可行方案。

研究方法：本研究为横断面观察性研究，数据来源于符合纳入标准患者的病历资料。研究依据巴西血管病与血管外科学会（Brazilian Society of Angiology and Vascular Surgery, SBACV）发布的VTE风险分层指南，对内科与外科患者的规范VTE预防处方率进行对比与评估。

研究结果：整体规范VTE预防处方率为42.1%，另有57.9%的患者未得到规范的预防管理。其中内科患者的规范预防率为52.9%，外科患者的对应比例为37.5%。

结论：VTE规范预防处方率仍未达到理想水平。持续开展教育培训、推行床旁风险分层措施以及优化电子处方系统，或可有效提升规范VTE预防的实施比例。