A survey of extent of venous thfomboembolism prophylaxis among medical in-patients in Kenyatta National Hospital

Abstract

B a c k g r o u n d : Venous thromboembolism comprises both deep venous thrombosis (DVT) and p u l m o n a r y embolism (PE). It accounts for approximately 10% of deaths in hospitals and has been i d e n t i f i e d as the most preventable cause of death during hospitalization. Along with the mortality a s s o c i a t e d with venous thromboembolism, long term complications, such as post thrombotic s y n d r o m e , affect a patient's quality of life and result in significantly increased health care costs, m o r b i d i t y and mortality. Objective: The main purpose of this study was to carry out a baseline survey of extent of venous thromboembolism prophylaxis among medical in-patients in Kenyatta national Hospital. Setting: Kenyatta National Hospital, which is the largest teaching and referral centre in Kenya. Study design: The study was a cross sectional study. Methodology: The target population was the medical in-patients with high risks of developing venous thromboembolism. One hundred and sixty eight (168) patients were selected by purposive sampling from medical in patients. Data was collected using venous thromboembolism prophylaxis risk assessment tool,and analysed by SPSS Results: Of the 168 patients studied, (40%) were not given prophylaxis, (52%) got prophylaxis and 8% had contraindications to chemical prophylaxis. Prevalence of VTE was 18.5% and the gender ratio was similar 1:1. The drugs used were heparin (65.6%), enoxaparin 18.3%, warfarin 9.7%, warfarin and heparin concurrently used were 6.5%. No patient was put on non pharmacological prophylaxis. Conclusion: The prevalence of venous thromboembolism in Kenyatta National Hospital which stands at 18.5% is higher than in the ones documented in literature that is 10-13% .The extent of provision of VTE prophylaxis is still low at 52%. Of the population that required prophylaxis only 52% were given while a big proportion 40% were left out. There are no non pharmacological interventions being given to patients having contraindications to chemical prophylaxis this left them prone to development of VTE. Active bleeding and uncontrolled hypertension were the major contraindications to pharmacological prophylaxis