Majority Of Hospitalized Patients Are At Risk For VTE
Venous thromboembolism risk is high among hospital patients and most of these at-risk patients are not protected with adequate prophylaxis.
VTE is a preventable disease which contributes significantly to morbidity and mortality among patients hospitalized for acute medical and surgical illnesses. Many complications and deaths due to VTE could be prevented using thromboprophylaxis as recommended by evidence based guidelines, but some studies have shown that there is a gap between evidence and practice in the hospital setting. Lack of awareness and uncertainty about the prevalence of patients at risk for VTE are among the major reasons accounting for this gap (1, 2). To date, there has been no large international study performed in hospitals selected at random around the world to evaluate VTE risk and prophylaxis practice globally.
ENDORSE collected data on more than 60,000 patients who were surveyed across 358 acute care hospitals randomly selected in 32 countries, encompassing 5 continents. All participating hospitals followed the same standard multinational protocol to survey the patients present in the wards.
The main objectives of ENDORSE were to assess the prevalence of VTE risk in the acute hospital care setting and to determine the proportion of at-risk patients who receive recommended prophylaxis using the definition of patients at risk of VTE and prophylaxis recommendations provided by the American College of Chest Physicians (ACCP) evidence-based consensus guidelines (3). The study included two categories of hospitalized patients: patients in medical wards 40 years of age or older, and patients in surgical wards, 18 years or older.
Doctor Fred Anderson, Director of the Center for Outcomes Research at the University of Massachusetts Medical School who conducted the study commented "ENDORSE is the first study to provide a global view of VTE risk and prophylaxis practices throughout the world. With more than 60,000 patients studied in more than 30 countries, the scope of ENDORSE is unprecedented. In view of the quality of the data collected and a common method to assess patients at risk for VTE and prophylaxis used, this study gives us a unique picture both globally and locally about the extent of the hospitalized patient population at risk for VTE and how these patients are managed."
ENDORSE demonstrates the high prevalence of patients at risk for VTE: 52% of hospitalized patients surveyed were at risk for VTE, corresponding to 64% of surgical patients and 42% of medical patients. The prevalence of patients at risk was consistent across the countries surveyed, demonstrating the importance of VTE risk on a global scale.
Importantly, when considering the use of recommended prophylaxis in hospitals, only 50% of hospitalized patients at risk for VTE received a method of prophylaxis recommended by the ACCP, corresponding to 59% of surgical and 40% of medical patients at risk for VTE. The use of recommended prophylaxis varied across countries; however, it was globally sub-optimal and even more so in medical than surgical patients, as the majority of medical patients at risk for VTE (60%) did not receive recommended prophylaxis.
As highlighted by Doctor Victor Tapson, Co-chair of the ENDORSE Steering Committee: "ENDORSE clearly shows that VTE is a critical safety issue in hospitalized patients, as the majority of them are at risk for VTE. This is really a global concern as a high proportion of patients at risk for VTE is observed across all the countries surveyed. Importantly, ENDORSE showed that one out of 2 hospitalized patients at risk for VTE were not receiving any recommended form of prophylaxis. It definitely shows that there is globally a sub-optimal use of VTE prophylaxis and this is even more pronounced among medically ill patients."
Commenting on the study, Doctor Ander Cohen, Co-chair of the ENDORSE Steering Committee, said "ENDORSE findings provide strong evidence of the need to increase awareness about the high prevalence of VTE risk among hospitalised medical and surgical patients. Importantly, it highlights the need to significantly improve the use of appropriate prophylaxis in patients at risk for VTE. In the United States for instance, VTE prophylaxis has been identified as the number #1 strategy to improve patient safety in the hospital. If we want to improve hospital patient outcomes, we urgently need to implement hospital-wide strategies to identify all surgical and medical patients at risk for VTE and provide appropriate prophylaxis to prevent VTE."