Assessment of venous thromboembolism prophylaxis in a South African private hospital group

Abstract

Background: Prophylactic venous thromboembolism (VTE) strategies have the greatest impact on patient outcomes. Both global and local guidelines support VTE prophylaxis for hospitalized patients. However, studies have reported that these measures are routinely under-prescribed. This study evaluated prescribing patterns of VTE prophylaxis in one of the largest South African (SA) private hospital groups. Methods: A quantitative, retrospective analysis of the hospital group's patient database was conducted for patients admitted between 1 September 2015 and 31 August 2016. Those younger than 18 years, with trauma or suffering from contraindications to anticoagulation were excluded. Additionally, patients with warfarin billed were also excluded as they possibly required therapeutic anticoagulation. Included prophylactic measures were compared to published SA guidelines by abstracting prophylaxis type and dosing, according to corresponding individual patients' VTE risk rating. Results: Among the 373 020 patients included as study population (with a mean age of 49.08 years and a 38:62 percent split between male and female), 77% required prophylaxis. Of these, 32.81% received some sort of prophylactic measure during their hospital stay. In patients where prophylaxis was indicated, only 24.56% complied with SA guidelines. The most commonly used prophylactic measures where enoxaparin (89.09%) and fondaparinux (2.68%). Prophylactic measures differed per geographical location and speciality - with the highest use in the Tshwane region and most compliant amongst intensivists. Conclusions: Less than 24.56% of patients who required prophylaxis received guideline appropriate interventions. Further studies should focus on understanding differences in practice and to improve acceptance of guideline-driven care.