Venous Thromboembolism Risk and Thromboprophylaxis Assessment in Surgical Patients Based on Caprini Risk Assessment Model

Abstract

Purpose

Venous thromboembolism (VTE) is the most common preventable cause of hospitalization-associated mortality. In the absence of optimal prophylaxis and depending on the type of surgery and patient-related factors, the risk of developing VTE increases by 10% to 50%. We aimed to assess VTE risk and thromboprophylaxis among surgical patients hospitalized at surgical wards of Tikur Anbessa Specialized Hospital (TASH). Addis Ababa, Ethiopia.

Materials and Methods

A retrospective cross-sectional study was conducted from September 1, 2018 to February 28, 2019. Data were collected using a pretested observational checklist which is prepared based on the VTE Caprini risk assessment model. Then, the collected data were checked for completeness and finally entered and analyzed using Statistical Package for Social Sciences (SPSS) version 25.

Results

Out of 155 admitted patients, almost equal numbers of males (49.68%) and females (50.32%) participated in the study with a mean age of 41.87±16.84 and an age range of 13 to 89 years. Undergoing major surgery, resting in bed for more than 3 days and having acute infections (including pneumonia) were the most frequently seen VTE risk factors. Most of the study participants (135, 87.10%) were at risk of developing VTE (>1 Caprini risk score), and 47.11% were in the highest risk category (≥5 Caprini score). The maximum and minimum total risk scores were 19 and 1, respectively with a mean score of 4.53±2.31. Among patients who were at risk of developing VTE and eligible for thromboprophylaxis, only 17.78% received thromboprophylaxis and two ineligible patients received prophylaxis. Parental unfractionated heparin twice or three times per day was the most widely used thromboprophylaxis regimen. A total of 29 (18.71%) patients had one or more contraindication(s) for thromboprophylaxis and three of them took prophylaxis despite the contraindications. Only 3 (1.93%) patients admitted to surgical wards developed VTE during hospitalization.

Conclusion

As per the Caprini risk assessment model, the majority of surgical patients treated at TASH were at risk of developing VTE. However, thromboprophylaxis was underutilized. The incidence of VTE was 1.93% in our study.

Keywords:

• VTE risk
• Caprini risk score
• thromboprophylaxis
• surgical patients
• Tikur Anbessa Specialized Hospital
• Ethiopia

Acknowledgments

The authors acknowledge Tikur Anbessa Specialized Hospital for allowing us to conduct this research. Furthermore, we would like to thank the study participants and data collectors and hospital record room staff for their time and facilitation of the data collection process.

Abbreviations

ACCP, American College of Chest Physicians; ASH, American Society of Hematology; DVT, deep vein thrombosis; DOACs, direct oral anticoagulants; PE, pulmonary embolism; RAM, risk assessment model; SPSS, Statistical Package for Social Sciences; TASH, Tikur Anbessa Specialized Hospital; UFH, unfractionated heparin; VTE, venous thromboembolism; VKAs, vitamin K antagonists.

Data Sharing Statement

All data used and/or analyzed during this study are included in this article and are available from the corresponding author upon reasonable request.

Ethical Approval and Informed Consent

Ethical clearance was obtained from the Ethical Review Board of the School of Pharmacy, College of Health Sciences Addis Ababa University, Addis Ababa, Ethiopia and then permission was obtained from the hospital to conduct the study. Information obtained from the data collected during the study was only handled by the research team. Informed consent was waived as the study was conducted retrospectively and also we did not encounter the study participants directly. This study was conducted in accordance with the Declaration of Helsinki.

Author Contributions

All authors made a significant contribution to the work reported, whether that was in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

We have not received funding for this study.