Summary
Limited data are available regarding the risk for venous thromboembolism (VTE) and
VTE prophylaxis use in hospitalised medically ill patients. We analysed data from
the global ENDORSE survey to evaluate VTE risk and prophylaxis use in this population
according to diagnosis, baseline characteristics, and country. Data on patient characteristics,
VTE risk, and prophylaxis use were abstracted from hospital charts. VTE risk and prophylaxis
use were evaluated according to the 2004 American College of Chest Physicians (ACCP)
guidelines. Multivariable analysis was performed to identify factors associated with
use of ACCP-recommended prophylaxis. Data were evaluated for 37,356 hospitalised medical
patients across 32 countries. VTE risk varied according to medical diagnosis, from
31.2% of patients with gastrointestinal/hepatobiliary diseases to 100% of patients
with acute heart failure, active non-infectious respiratory disease, or pulmonary
infection (global rate, 41.5%). Among those at risk for VTE, ACCP-recommended prophylaxis
was used in 24.4% haemorrhagic stroke patients and 40–45% of cardiopulmonary disease
patients (global rate, 39.5%). Large differences in prophylaxis use were observed
among countries. Markers of disease severity, including central venous catheters,
mechanical ventilation, and admission to intensive care units, were strongly associated
with use of ACCP-recommended prophylaxis. In conclusion, VTE risk varies according
to medical diagnosis. Less than 40% of at-risk hospitalised medical patients receive
ACCP-recommended prophylaxis. Prophylaxis use appears to be associated with disease
severity rather than medical diagnosis. These data support the necessity to improve
implementation of available guidelines for evaluating VTE risk and providing prophylaxis
to hospitalised medical patients.
Keywords
ACCP guideline use - ENDORSE - hospitalised medical patients - prophylaxis - venous
thromboembolism