Optimizing the prophylaxis of hospital-acquired deep vein thrombosis and pulmonary thromboembolism

Nazarenko G.I.; Kleymenova E.B.; Payushchik S.A.; Otdelеnov V.A.; Sychev D.A.

doi:https://doi.org/10.17116/terarkh201688923-30

Nazarenko G.I.

Meditsinskiĭ tsentr Banka Rossii, Moskva

Kleymenova E.B.

Medical Center, Bank of Russia, Moscow, Russia

Payushchik S.A.

Medical Center, Bank of Russia, Moscow, Russia

Otdelеnov V.A.

Medical Center, Bank of Russia, Moscow, Russia

Sychev D.A.

Russian Medical Academy of Continuous Professional Education, Ministry of Health of the Russia, Moscow, Russia

ORCID: 0000-0002-4496-3680

Optimizing the prophylaxis of hospital-acquired deep vein thrombosis and pulmonary thromboembolism

Authors:

Nazarenko G.I., Kleymenova E.B., Payushchik S.A., Otdelеnov V.A., Sychev D.A.

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Journal: Therapeutic Archive. 2016;88(9): 23‑30

DOI: 10.17116/terarkh201688923-30

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To cite this article:

Nazarenko GI, Kleymenova EB, Payushchik SA, Otdelеnov VA, Sychev DA. Optimizing the prophylaxis of hospital-acquired deep vein thrombosis and pulmonary thromboembolism. Therapeutic Archive. 2016;88(9):23‑30. (In Russ.)
https://doi.org/10.17116/terarkh201688923-30

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Abstract:

Aim. To reduce the number of preventable hospital-acquired venous thromboembolic events (HA-VTE) and to improve the quality of VTE prophylaxis at multiprofile hospital. Materials and methods. A comprehensive approach to preventing HA-VTE was developed, which involved the global trigger tool method to assess adverse events, as well as the computerized clinical decision support system (CDSS) to prevent HA-VTE on the basis of relevant clinical practice guidelines, and HA-VTE registry. Results. A total of 50 patients (15 men, 35 women; their median age was 70.5 years) with HA-VTE were included in the HA-VTE registry in January 2014 to June 2015. Assessment of a trend in the prevalence of HA-VTE when introducing CDSS to prevent VTE showed its statistically significant decline in the total number of HA-VTE cases (χ2=7.325, df=1; p=0.0068) and in that of HA-VTE in surgical patients (χ2=7.266, df=1; p=0.0070). The statistical significance of χ2 for linear trend was not achieved for medical patients, which is probably due to the small sample size (χ2=2.764, df=1; p=0.0964). While introducing CDSS, there was a statistically significant reduction in the incidence of postoperative VTE from 8.76 to 4.17 cases per 1000 interventions (χ2=5.347, df=1; p=0.0208; the absolute values of HA-VTE and surgical interventions were used for the calculation). Conclusion. The proposed comprehensive approach can substantially increase the detection rate of HA-VTE and decrease its incidence rates. This requires a personified assessment of the risk of VTE and hemorrhage in all hospitalized patients on day 1 of their admission, timely initiation of recommended VTE prophylaxis, and dynamic assessment of the risk of VTE and hemorrhage for timely correction of the prophylaxis.

Keywords:

deep vein thrombosis

pulmonary thromboembolism

prophylaxis

hospital-acquired event

global trigger tool

clinical decision support system

Authors:

Nazarenko G.I.

Meditsinskiĭ tsentr Banka Rossii, Moskva

Kleymenova E.B.

Medical Center, Bank of Russia, Moscow, Russia

Payushchik S.A.

Medical Center, Bank of Russia, Moscow, Russia

Otdelеnov V.A.

Medical Center, Bank of Russia, Moscow, Russia

Sychev D.A.

Russian Medical Academy of Continuous Professional Education, Ministry of Health of the Russia, Moscow, Russia

ORCID: 0000-0002-4496-3680

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References:

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