O R I GI N A L A R T I CLE
D e e p v e n o u s t h r o m b o sis p r o p h y la x is: p r a ct ica l a p p lica t io n a n d t h e o r e t ica l
k n o w le d g e in a g e n e r a l h o sp it a l
Cr i st i a n o Al m e i d a P e r e i r aI, Sé r g i o So a r e s d e Br it oI I, An t o n i o Sa n se v e r o M a r t i n sI I I, Ch r i st i a n y M o r e i r a Al m e i d aI V
IResident (6th year), Medical School, Universidade Federal de Roraima (UFRR), Boa Vista, RR, Brazil. IIPhysician, vascular surgeon. Associate professor, Residence in Vascular Surgery, UFRR, Boa Vista, RR,
Brazil. Member, SBACV.
IIIPhysician, pediatric surgeon. General coordinator professor, Residence in Vascular Surgery, UFRR, Boa
Vista, RR, Brazil.
IVMedical student, 4th year, UFRR, Boa Vista, RR, Brazil.
Correspondence
J Vasc Bras. 2008;7(1):18-27.
A BST R A CT
Ba ck g r o u n d : Although this work belongs to the area of vascular surgery, it is relevant to all clinical and surgical specialties due to the clinical importance of deep venous thrombosis and its main complication, pulmonary embolism.
O b j e ct i v e s: To verify whether pharmacological prophylaxis of deep venous thrombosis is being
adequately and routinely used in our service and to evaluate physicians’ knowledge about the indications of deep venous thrombosis chemoprophylaxis.
M e t h o d s: A prospective study was accomplished including 850 patients hospitalized from March to May 2007 at Hospital Geral de Roraima. Clinical, pharmacological and surgical factors were researched. Risk stratification and evaluation of prophylaxis were established according to the classification suggested by the Brazilian Society of Angiology and Vascular Surgery and to the protocol developed by Caiafa in 2002. Physicians answered a questionnaire and analyzed three hypothetical clinical cases. Data were tabled and statistically analyzed with the support of the software Epi-Info 2002•.
Re su l t s: Of the 850 patients surveyed, 557 (66.66%) were clinical and 293 (33.34%) were surgical patients. Of the total, 353 (41.56%) had low risk, 411 (48.32%) medium risk and 86 (10.12%) high risk for development of deep venous thrombosis. Of the 497 patients that needed to receive
chemoprophylaxis for deep venous thrombosis, only 120 (24%) received it and of these, 102 (85%) received it adequately. Any patient who did not need prophylaxis received it. Clinical physicians prescribed prophylaxis more frequently and correctly than surgeons, although the latter have demonstrated better theoretical knowledge of the theme. In general, theoretical knowledge on deep venous thrombosis was insufficient.
Ke y w o r d s: Th r om b oem b olism , d eep v en ou s t h r om b osis, r isk f act or s, p r op h y lax is.
R ESU M O
Co n t e x t o : Tr ab alh o r ealizad o n a ár ea d e cir u r g ia v ascu lar , p or ém r elev an t e a t od as as esp ecialid ad es clín icas e cir ú r g icas d ev id o à im p or t ân cia clín ica d a t r om b ose v en osa p r of u n d a e su a p r in cip al
com p licação, a em b olia p u lm on ar .
O b j e t i v o s: Ver if icar se a pr of ilax ia p ar a a t r om b ose v en osa p r of u n d a est á sen d o u t ilizada d e f or m a ad eq u ad a e r ot in eir a em n osso ser v iço e av aliar o con h ecim en t o d os m éd icos sob r e as in d icações d e pr of ilax ia m ed icam en t osa.
M é t o d o s: Foi r ealizad o u m est u d o p r osp ect iv o com 8 5 0 p acien t es in t er n ad os d e m ar ço a m aio d e 2 0 0 7 n o Hosp it al Ger al d e Ror aim a. For am p esq u isad os f at or es clín icos, m ed icam en t osos e cir ú r g icos. A est r at if icação d e r isco e a av aliação d a pr of ilax ia f or am est ab elecid as con f or m e a classif icação r ecom en d ad a p ela Socied ad e Br asileir a d e An g iolog ia e Cir u r g ia Vascu lar e o p r ot ocolo r ealizad o p or Caiaf a em 2 0 0 2 . Os m éd icos r esp on d er am a u m q u est ion ár io e an alisar am t r ês casos clín icos
h ip ot ét icos. Os d ad os f or am t ab u lad os e an alisad os est at ist icam en t e u san d o o p r og r am a d e com p u t ad or Ep i- I n f o 2 0 0 2 ® .
R e su l t a d o s: Dos 8 5 0 p acien t es est u d ad os, 5 5 7 ( 6 6 , 6 6 % ) er am clín icos e 2 9 3 ( 3 3 , 3 4 % ) cir ú r g icos. Do t ot al, 3 5 3 p acien t es ( 4 1 , 5 6 % ) f or am classif icad os com o b aix o r isco, 4 1 1 ( 4 8 , 3 2 % ) com o m éd io r isco e 8 6 ( 1 0 , 1 2 % ) com o alt o r isco p ar a d esen v olv er t r om b ose v en osa p r of u n d a. Dos 4 9 7 p acien t es q u e n ecessit av am r eceb er pr of ilax ia m ed icam en t osa p ar a t r om b ose v en osa p r of u n d a, ap en as 1 2 0 ( 2 4 % ) a r eceb er am ; d est es, 1 0 2 ( 8 5 % ) a r eceb er am d e f or m a cor r et a. Dos q u e n ão n ecessit av am d e pr of ilax ia, n en h u m a r eceb eu . Os clín icos p r escr ev er am m ais e d e f or m a m ais cor r et a a pr of ilax ia em r elação aos cir u r g iões, ap esar d e est es t er em d em on st r ad o p ossu ir u m m elh or con h ecim en t o t eór ico d o t em a. No g er al, o con h ecim en t o t eór ico sob r e t r om b ose v en osa p r of u n d a f oi in su f icien t e.
Co n cl u sõ e s: Em n osso ser v iço, a pr of ilax ia m ed icam en t osa d a t r om b ose v en osa p r of u n d a é
su b u t ilizad a em p acien t es co m in d icação p ar a r eceb ê- la, t or n an d o n ecessár ia a im p lem en t ação d e u m p r og r am a d e ed u cação con t in u ad a sob r e o t em a.
P a l a v r a s- ch a v e : Tr om b oem b olism o, t r om b ose v en osa p r of u n d a, f at or es d e r isco, p r of ilax ia.
I n t r o d u ct io n
Th e or ig in of d eep v en ou s t h r om b osis ( DVT) can b e an aly zed b ased on Vir ch ow ' s t r iad, d escr ib ed in 1 8 5 6 . St asis, en d ot h elial lesion an d h y p er coag u lab ilit y , com b in ed or alon e, ar e f act or s associat ed w it h it s et iop at h og en ic g en esis.1
DVT, w h ich h as m u lt id iscip lin ar y occu r r en ce, is a f r eq u en t an d sev er e en t it y , m ain ly r esu lt in g f r om ot h er su r g ical or clin ical af f ect ion s. I t s m ost sev er e com p licat ion s ar e acu t e p u lm on ar y em b olism ( PE) an d lat e p ost t h r om b ot ic sy n d r om e.2
I n n ecr op sy - b ased st u d ies, t h r om b oem b olism w as t h e m ost com m on cau se of p r ev en t ab le h osp it al m or t alit y an d m or b id it y an d m or t alit y in su r g ical p at ien t s, an d also accou n t ed f or 3 0 0 , 0 0 0- 6 0 0 , 0 0 0 h osp it alizat ion s a y ear .6Wh en f at al, d eat h u su ally occu r s in t h e f ir st h ou r , an d d iag n osis is u su ally n ot ev en con sid er ed .7
I n ou r cou n t r y , t h er e h as b een as est im at e of 6 0 cases p er 1 0 0 , 0 0 0 in h ab it an t s/ y ear , b ased on DVT cases con f ir m ed b y p h leb og r ap h y or d u p lex scan n in g ( DS) .8I n a st u d y p er f or m ed in São Pau lo, r esu lt s of 5 , 2 6 1 n ecr op sies w er e an aly zed . PE w as f ou n d in 1 0 . 3 4 % of p at ien t s, b ein g t h e m ain cau se of d eat h in 4 . 2 7 % of cases. An t e m or t em r at e f or u n su sp ect ed p u lm on ar y t h r om b oem b olism ( PTE) w as 8 4 % , an d 4 0 % of t h ese p at ien t s h ad f at al PTE.9I n an ot h er st u d y con d u ct ed in ou r cou n t r y , 7 6 7 n ecr op sies w er e p er f or m ed b et w een 1 9 8 5 an d 1 9 9 5 , w h en v en ou s t h r om b oem b olism ( VTE) w as iden t if ied in 3 . 9 % of cases; of t h ese, in 8 3 % VTE h ad n ot b een p r ev iou sly d iag n osed or con sid er ed .10
Most VTE cases seem t o b e associat ed w it h clin ical sit u at ion s of w ell d ef in ed r isk s, called r isk f act or s. For m an y d ecad es, clin ical an d ep id em iolog ical ob ser v at ion s p er f or m ed b y v ar iou s au t h or s in d if f er en t cou n t r ies allow ed id en t if icat ion of a ser ies of f act or s an d d iseases p r eced in g or f ollow in g clin ical cases of v en ou s t h r om b osis.11 - 13
I n t h e sam e p er iod , it h as b een ob ser v ed t h at b ot h clin ical an d su r g ical p at ien t s w it h a h ig h er n u m b er of r isk f act or s w er e m or e lik ely t o d ev elop t h r om b osis, w h ich led m an y au t h or s t o d ev elop p r og n ost ic assessm en t m et h od s u sin g t ab les. I n t h ese t ab les, each f act or is g iv en an ab solu t e or p er cen t ag e
v alu es. I f a p at ien t h as t h e su m of t h ose p ar t ial v alu es h ig h er t h an a g iv en v alu e, h e is con sid er ed a r isk p at ien t f or t h r om b oem b olic d isease, an d f or t h at r eason , d eser v es sp ecial at t en t ion , in clu d in g occasion al p r op h y lact ic an t icoag u lat in g d r u g t h er ap y .1 4 , 1 5
Now ad ay s, in ou r cou n t r y , t h e p r ot ocol of DVT p r op h y lax is d ev elop ed b y Socied ad e Br asileir a d e
An g iolog ia e d e Cir u r g ia Vascu lar ( SBACV)14 an d t h e p r ot ocol u sed in a lar g e st u d y p er f or m ed in 2 0 0 1 at Hosp it al Nav al Mar cílio Dias16 h av e b een u sed in t h e p r ocess of r isk classif icat ion an d t o d ef in e t h e t y p e of p r op h y lax is in m an y st u d ies.
Th er ef or e, ev er y p at ien t t h at is h osp it alized sh ou ld b e assessed as t o r isk of d ev elop in g DVT an d sh ou ld b e g iv en p r op er p r op h y lax is w h en ev er n ecessar y . Ef f ect iv en ess of t h at ap p r oach h as b een w id ely d em on st r at ed in t h e lit er at u r e an d r eassu r ed in n at ion al an d in t er n at ion al con sen su s st at em en t s, w it h d et ailed r ecom m en d at ion s t o all classes of h osp it alized p at ien t s.1 4 , 1 5 , 1 7
How ev er , d esp it e all p r ot ocols of DVT p r ev en t ion b ein g av ailab le t o all m ed ical p r act it ion er s an d t h e lar g e am ou n t of st u d ies an d act iv it ies d ev elop ed in t h is ar ea, r ecen t p u b licat ion s h av e su g g est ed t h at ad op t ion of p r op h y lact ic m easu r es in g en er al h osp it als is st ill u n sat isf act or y .18
Th is st u d y aim s at v er if y in g w h et h er DVT p r op h y lax is is b ein g r ou t in ely an d p r op er ly u sed in ou r ser v ice, as w ell as ev alu at in g p h y sician s' k n ow led g e on r isk classif icat ion s an d in d icat ion s of d r u g p r op h y lax is f or DVT, com p ar in g t h at k n ow led g e t o it s p r act ical ap p licat ion in t h eir p at ien t s.
M e t h o d s
A p r osp ect iv e coh or t st u d y w as car r ied ou t f r om Mar ch t h r ou g h May 2 0 0 7 at Hosp it al Ger al d e Ror aim a, a h osp it al b elon g in g t o t h e st at e p u b lic n et w or k t h at h as 2 5 0 b ed s an d is a r ef er en ce in t er t iar y m ed ical car e t o p at ien t s ag ed 1 3 y ear s or old er in t h e St at e of Ror aim a, Br azil. Th e h osp it al also p r ov id es car e t o p at ien t s of n eig h b or in g cou n t r ies, su ch as Ven ezu ela an d Gu ian a, an d h as a p ar t n er sh ip w it h
Ex clu sion cr it er ia w er e p at ien t s w it h ou t h osp it al st ay au t h or izat ion ( HSA) an d / or p er m an en ce sh or t er t h an 2 4 h ou r s, r ef u sal t o p ar t icip at e in t h e st u d y an d p at ien t s y ou n g er t h an 1 8 y ear s. Clin ical, d r u g an d su r g ical f act or s f or DVT w er e assessed in all p at ien t s in clu d ed in t h e st u d y t h r ou g h a p r ev iou sly
d ev elop ed p r ot ocol.
Pat ien t s w er e g r ou p ed in t o low , m ed iu m an d h ig h r isk t o d ev elop DVT, an d p r op h y lax is r eceiv ed w as com p ar ed w it h p r op er in d icat ion an d u se of p r op h y lax is accor d in g t o t h e af or em en t ion ed p r ot ocols.1 4 . 1 6 Af t er d at a w er e collect ed , a q u est ion n air e w as ap p lied t o assist an t p h y sician s in clu d in g sev en q u est ion s an d t h r ee h y p ot h et ic cases w it h alt er n at iv es r eg ar d in g p r op er p r op h y lact ic con d u ct . Ph y sician s an sw er ed t h e q u est ion n air es in t h e p r esen ce of t h e in t er v iew er , r et u r n in g t h em im m ed iat ely . Fin ally , r esu lt s ob t ain ed w it h t h e q u est ion n air es w er e cor r elat ed t o t h e p r act ice ap p lied b y t h e p h y sician s on t h eir h osp it alized p at ien t s.
Th e sof t w ar e Micr osof t ® Of f ice Ex cel 2 0 0 3 w as u sed t o t ab le r esu lt s an d cr eat e g r ap h s. Dat a w er e st at ist ically an aly zed u sin g t h e sof t w ar e Ep i- I n f o 2 0 0 2 ® . Th is sof t w ar e w as u sed t o calcu lat e f r eq u en cies an d p er cen t ag es of v ar iab les, con sid er in g as st at ist ically sig n if ican t p < 0 , 0 5 .
Re su lt s
Fr om Mar ch t h r ou g h May 2 0 0 7 , 8 5 0 p at ien t s ad m it t ed at Hosp it al Ger al d e Ror aim a m et t h e in clu sion cr it er ia an d con sen t ed t o p ar t icip at e in t h e st u d y , accou n t in g f or a t ot al of 3 6 % of h osp it alizat ion s in t h at p er iod ; of t h ese, 3 4 7 ( 4 0 . 8 % ) w er e m en an d 5 0 3 ( 5 9 . 2 % ) w er e f em ale. Risk st r at if icat ion f or d ev elop m en t of DVT accor d in g t o g en d er can b e seen in Tab le 1.
Clin ical an d su r g ical p at ien t s w er e su b d iv id ed in t o su r v ey ed sp ecialt ies. Resu lt can b e seen in Tab le 3.
Of t h e t ot al, 5 5 7 ( 6 6 . 6 6 % ) w er e clin ical p at ien t s an d 2 9 3 ( 3 3 . 3 4 % ) w er e su r g ical p at ien t s. Of clin ical p at ien t s, 2 3 4 w er e st r at if ied as low r isk , 2 9 1 as m ed iu m r isk an d 3 2 as h ig h r isk . As t o su r g ical p at ien t s, 1 1 9 h ad low r isk t o d ev elop DVT, 1 2 0 m ed iu m r isk an d 5 4 h ig h r isk . Tab les 5 an d 6 su m m ar ize in
p er cen t ag es an d ab solu t e n u m b er s p at ien t s t h at r eq u ir ed p r op h y lax is, p at ien t s t h at r eceiv ed it an d ad eq u acy in t h ose t h at w er e g iv en p r op h y lax is. Th ese d at a h ad m aj or st at ist ical sig n if ican ce ( p < 0 , 0 2 ) .
( 3 . 1 v er su s 1 . 9 ; p < 0 . 0 5 ) . How ev er , t h e h ig h er t h e ab solu t e n u m b er of r isk f act or s, t h e less f r eq u en t ly p r op h y lax is w as u sed . Th is f act can b e ex p lain ed b y t h e lit t le or n o u se of p r op h y lax is in som e p at ien t s r eq u ir in g it . Av er ag e n u m b er of r isk f act or s w as 0 . 8 9 in low- r isk p at ien t s, 2 . 9 in m ed iu m - r isk p at ien t s an d 5 . 2 in h ig h - r isk p at ien t s ( p < 0 . 0 1 ) . Tab le 7 h as d at a on u se of p r op h y lax is p r esen t ed accor d in g t o n u m b er of r isk f act or s.
Com p ar ison of p r op h y lax is r at e u sed in p r act ice b y clin ician s an d su r g eon s, in p at ien t s in d icat ed t o r eceiv e it , sh ow ed t h at clin ician s p r escr ib e p r op h y lax is f or t h eir p at ien t s m or e f r eq u en t ly t h an su r g eon s. Su ch d if f er en ce w as st at ist ically sig n if ican t ( p < 0 , 0 1 ) .
As t o sp ecialt ies in clu d ed in t h e st u d y , on ly or t h op ed ics d id n ot u se d r u g p r op h y lax is f or DVT in an y p at ien t . Car d iolog y w as t h e sp ecialt y t h at m ost u sed p r op h y lax is, ap p ly in g it in 4 9 . 3 9 % of cases. Th er e w as n o st at ist ically sig n if ican t d if f er en ce in u se of p r op h y lax is b et w een su r v ey ed sp ecialt ies. Per cen t ag e of p r op h y lax is u se in su r v ey ed sp ecialt ies is sh ow n in Fig u r e 2.
D iscu ssio n
Risk of VTE is h ig h in su r g ical p at ien t s an d in t h ose h osp it alized f or t r eat m en t of clin ical d iseases. I n t h e ex ist in g lit er at u r e on t h is t h em e, t h e im p or t an ce an d b en ef it s of p r op er an d ef f ect iv e d r u g p r op h y lax is in r elat ion t o DVT is w ell d ocu m en t ed , an d is w id ely su p p or t ed f or b ein g b et t er r eg ar d in g all asp ect s in t h e t r eat m en t of set t led d isease. Resu lt s of v ar ied con t r olled an d r an d om ized st u d ies h av e ser v ed t o
d em on st r at e in t er v en t ion s ab le t o sig n if ican t ly r ed u ce r isk of VTE in t h ese p at ien t s.1 1 , 1 3 , 1 5 How ev er , VTE is st ill t h e m ain cau se of su d d en d eat h in h osp it alized p at ien t s,5 p r ob ab ly d u e t o lack of in f or m at ion ab ou t it s in cid en ce. I n a st u d y car r ied ou t in 1 9 9 8 , in clu d in g 3 0 0 p h y sician s in Br azil, on ly 1 5 . 6 % of t h em w er e f u lly aw ar e of VTE in cid en ce.19
A st u d y p er f or m ed in 2 0 0 4 r ev ealed t h at 3 8 . 4 6 % of in t er v iew ed p h y sician s w er e aw ar e of DVT
in cid en ce.20 At Hosp it al Ger al d e Ror aim a, 3 1 . 1 % of p h y sician s r ep or t ed k n ow in g DVT in cid en ce in ou r cou n t r y . I n ou r st u d y an d in ot h er s, su ch as t h ose b y Mar ch i et al. ,21 Caiaf a & Bast os,16 Roch a et al.22 an d Deh ein zelin et al. ,23 all p er f or m ed in Br azil, an d t h ose b y Vallan o et al.24 an d Ch op ar d et al. ,25 p er f or m ed in ot h er cou n t r ies, w e can ob ser v e t h at m ost p h y sician s d o n ot su b m it p at ien t s w it h id en t if ied r isk of DVT t o p r op h y lax is (Tab le 1 0) . Accor d in g t o Ar n old et al. , in ad eq u at e p r op h y lax is is m or e
A st u d y p u b lish ed in 1 9 9 9 d em on st r at ed t h at t h er e ar e f ailu r es in id en t if icat ion an d r isk classif icat ion of p at ien t s. Risk f act or s su ch as im m ob ilit y an d ob esit y w er e easily r em em b er ed . How ev er , r isk of
t h r om b osis associat ed w it h can cer w as u n d er est im at ed .26 An ot h er p ossib le f act or f or n ot u sin g p r op h y lax is, esp ecially in su r g ical p at ien t s, can b e f ear of m aj or b leed in g , alt h ou g h it h as b een d em on st r at ed t h at u se of p r op h y lact ic ag en t s d id n ot in cr ease r isk of b leed in g d u r in g p r oced u r es.27
Th e m ost f r eq u en t r isk f act or s f ou n d in ou r p at ien t s w er e, r esp ect iv ely , ag e old er t h an 4 0 y ear s ( 2 3 . 8 % ) , d iab et es m ellit u s ( 2 1 . 5 % ) , p r olon g ed su r g er y t im e ( 1 5 % ) , sev er e in f ect ion ( 5 % ) an d b ed r est r ict ion lon g er t h an 3 d ay s ( 3 % ) . I n t h e st u d y b y Caiaf a & Bast os, t h e m ain r isk f act or s w er e ag e old er t h an 4 0 y ear s ( 2 5 . 8 % ) , p r eg n an cy ( 2 5 . 3 % ) , p r olon g ed su r g er y t im e ( 1 6 . 1 % ) an d ob esit y ( 5 . 8 % ) .16 I n a st u d y p er f or m ed in Sp ain , t h e m ain r isk f act or s w er e ag e old er t h an 4 0 y ear s ( 8 4 % ) , m aj or su r g er ies ( 3 7 % ) , im m ob ilizat ion ( 3 6 . 5 % ) , can cer ( 3 2 % ) , ob esit y ( 1 5 % ) , an d con g est iv e h ear t f ailu r e ( 6 % ) .24 As can b e seen , ag e old er t h an 4 0 y ear s w as t h e m ost f r eq u en t ly f ou n d r isk f act or in all t h r ee st u d ies.
I n ou r st u d y , of t h e 4 9 7 p at ien t s in d icat ed t o r eceiv e p r op h y lax is, 3 7 7 d id n ot r eceiv e it . Con sid er in g t h e t w o m ain d iv ision s u sed , m or e om ission w as ob ser v ed in su r g ical p at ien t s: 9 0 % ( 1 5 8 / 1 7 4 ) of m ed iu m -an d h ig h - r isk p at ien t s w er e n ot g iv en d r u g p r op h y lax is. I n t h e clin ical g r ou p , 3 2 . 2 % ( 1 0 4 / 3 2 3 ) of p at ien t s w it h in d icat ion w er e n ot g iv en p r op h y lax is. Th ese r esu lt s ar e sim ilar t o t h ose f ou n d in t h e lit er at u r e,1 6 , 2 0 , 2 1 b ein g on ly d if f er en t f r om t h e r esu lt s f ou n d in a st u d y car r ied ou t in Bah ia, Br azil, in 2 0 0 6 , in w h ich lack of p r op h y lax is w as m or e f r eq u en t ly f ou n d am on g clin ical p at ien t s.22 Th e d at a sh ow t h at w e h ad on e of t h e w or st r at es as t o n u m b er of p at ien t s w h o w er e g iv en p r op h y lax is w h en in d icat ed . On t h e ot h er h an d , as t o p r op er p r op h y lax is in p at ien t s w h o w er e g iv en it , ou r r esu lt s sh ow ed t h e b est ad eq u acy r at e com p ar ed t o st u d ies an aly zin g t h is v ar ian t . I n ou r st u d y , p r op h y lax is w as p r op er ly p er f or m ed in 8 5 % of p at ien t s, h av in g h ig h st at ist ical sig n if ican ce ( p < 0 , 0 5 ) . I n ou r h ospit al, t h e m ain f ailu r e is f ou n d in m ed iu m - r isk p at ien t s, an d su r g eon s p r escr ib e p r op h y lax is less f r eq u en t ly t h an
clin ician s. Car d iolog y w as t h e sp ecialt y t h at m ost u sed p r op h y lax is f or DVT, b u t it w as n ot sat isf act or y in an y sp ecialt y . I n m or e t h an 2 / 3 of p at ien t s w it h p ot en t ial r isk of DVT d ev elop m en t , an y p r op h y lact ic m easu r e w as p er f or m ed .
Such inadequacy in medical conduct regarding DVT prophylaxis is not unusual, despite the disclosure of prophylactic recommendations over the past 2 decades. In the USA, only a minority of physicians performs systematic prophylaxis, which is more used in university units. A prospective study performed in 1994 showed increase in use of prophylaxis from 29 to 52% in hospitalized patients with potential risk of developing venous thrombosis after implementation of a continuous education program, which has thromboembolism as the main theme, showing that interventions of that nature are extremely
important. That same study confirmed that in hospitals in which physicians continuously participated in education programs, use of prophylaxis was higher.27
In 1999, Caiafa & Bastos28started a Brazilian register with the aim of investigating incidence of risk factors for TVE in clinical and surgical hospitalized patients and investigating use of prophylaxis in these populations. Data obtained showed significant improvement in rates of drug prophylaxis use for DVT, a result that can be explained by the implementation of a continuous education system during the study.28
Co n clu sio n
Despite the benefits of prophylaxis for DVT being widely confirmed in the literature, it is not practiced by many physicians, both clinicians and surgeons, as corroborated in many studies, including ours,
performed at Hospital Geral de Roraima. The fact can be explained by the unsatisfactory theoretical knowledge shown by such practitioners.
This study demonstrates that non-use of prophylaxis for DVT can be a consequence of physicians' lack of knowledge of its indications. Therefore, new strategies, such as continuous education and awareness programs, should be developed, encouraged and applied to improve theoretical knowledge and practical use of that knowledge by medical practitioners, so that improvement in rates of prophylaxis use in hospitalized patients can be expected.
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Co r r e sp o n d e n ce :
Cristiano Almeida Pereira
Av. Dr. Reinaldo Neves, 755, Bairro Jardim Floresta I CEP 693000-000 – Boa Vista, RR, Brazil
Tel.: (95) 8116.5286
Email: med.cristiano@gmail.com
This study was developed at Hospital Geral de Roraima, with which Universidade Federal de Roraima has a partnership for medical teaching.
