Original Research

Is guideline-driven prophylaxis for venous thromboembolism common practice in the South African private hospital setting?

Melissa van der Merwe, Marlene Julyan, Jesslee M. du Plessis
South African Family Practice | Vol 62, No 1 : Part 4| a5022 | DOI: https://doi.org/10.4102/safp.v62i1.5022 | © 2020 Melissa Van der Merwe, Marlene Julyan, Jesslee Melinda du Plessis | This work is licensed under CC Attribution 4.0
Submitted: 08 November 2019 | Published: 12 October 2020

About the author(s)

Melissa van der Merwe, Department of Medicine Usage in South Africa, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
Marlene Julyan, Department of Medicine Usage in South Africa, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
Jesslee M. du Plessis, Department of Medicine Usage in South Africa, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa

Abstract

Background: Prophylactic venous thromboembolism (VTE) strategies have the greatest impact on patient outcomes. Both global and local guidelines support VTE prophylaxis for hospitalised 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 01 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 with published SA guidelines by abstracting prophylaxis type and dosing, according to corresponding individual patients’ VTE risk ratings.

Results: Amongst the 373 020 patients included as the study population, 77% required prophylaxis. Of these, 38.36% (n = 85 486) received guideline-appropriate prophylactic measures during their hospital stay. Patients in whom prophylaxis was indicated, only 24.56% (n = 42 715) complied with the SA guidelines. The most commonly used prophylactic measures were enoxaparin (89.09%) and fondaparinux (2.68%). Prophylactic measures differed per speciality, with the most compliant amongst intensivists. A low uptake of the risk assessment model use (n = 222 860, 59.75%) was, however, reported for this data set.

Conclusion: Less than 24.56% of patients who required prophylaxis received guideline-appropriate interventions. Further studies should focus on understanding differences in practice and improving acceptance and application of guideline-driven care.


Keywords

venous thromboembolism; prophylaxis; hospital; South Africa; risk assessment

Metrics

Total abstract views: 2127
Total article views: 2923


Crossref Citations

No related citations found.