Suitability of the Use of Low-Molecular-Weight Heparins in the Prevention of Venous Thromboembolism

Garrido Martínez, M.T.; Aguayo Canela, M.; Herrera Carranza, J.; Chaparro Moreno, I.; Ynfante Ferrus, M.; de la Rosa Báez, J.A.; Fernández Lisón, L.C.

doi:10.1016/S2173-5085(08)70046-7

Farmacia Hospitalaria

ISSN: 1130-6343

Farmacia Hospitalaria (Farm Hosp) is the official publication of the Spanish Society of Hospital Pharmacists (SEFH), a professional and scientific organization that currently has about 4.351 members.

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Three hundred forty-five patients were included. The prevalence of LMWH use was 44.6% (95% CI, 39.3–50.1). Depending on the risk of thromboembolism, the decision to treat prophylactically (or not) was appropriate in 261 cases (75.7%; 95% CI, 70.7–80.1), and the action guidelines were not suitable for the remainder of patients. Fifty-five patients (15.9%; 95% CI, 12.2–20.2) presented a high risk and were not prescribed prophylactically (underuse); and 29 patients (8.4%; 95% CI, 5.7–11.8) at low risk were treated prophylactically (overuse). There was a relationship between the appropriateness of the prescription and the type of patient (P<.01). In the group of medical patients the prevalence of prescription was 22.6% (95% CI, 16.9–29.1) and only 33.3% of patients with a high to moderate risk of thromboembolism received prophylaxis. The prevalence of prescription in general surgery was 84.2% and 91.3% in traumatology.

Conclusions

The degree of prophylaxis is adequate in surgical patients, but there was a significant percentage of medical patients with a high to moderate risk who did not receive suitable prophylaxis (underuse), despite recommendations with scientific and professional backing.

Key words:

Prevalence

Cross-sectional studies

Drug utilization review

Venous thromboembolism

Prophylaxis

Low-molecular-weight heparins

Objetivo

Conocer la prevalencia de prescripción de heparinas de bajo peso molecular (HBPM) en la profilaxis de la enfermedad tromboembólica venosa en un hospital general, así como la adecuación a las recomendaciones de las guías de práctica clínica.

Método

Estudio observacional, descriptivo, de corte transversal, tipo indicación-prescripción, con pacientes ingresados en servicios médicos y quirúrgicos.

Resultados

Se incluyeron 345 pacientes. La prevalencia de prescripción de HBPM fue del 44,6% (intervalo de confianza [IC] del 95%, 39,3- 50,1). Según el nivel de riesgo tromboembólico se encontró adecuación en la decisión de tratar profilácticamente (o no) en 261 casos (75,7%; IC del 95%, 70,7–80,1), en el resto la pauta de actuación no fue la adecuada, destacando 55 pacientes (15,9%; IC del 95%, 12,2–20,2) con riesgo alto a los que no se había prescrito profilaxis (infrautilización), y 29 pacientes (8,4%; IC del 95%, 5,7–11,8) con riesgo bajo que estaban con profilaxis (sobreutilización) En los pacientes médicos la prevalencia de prescripción fue de 22,6% (IC del 95%, 16,9–29,1) y sólo el 33,3% de los de riesgo tomboembólico alto-moderado recibió profilaxis. La prevalencia de prescripción en cirugía general fue del 84,2% y en traumatología del 91,3%.

Conclusiones

En pacientes quirúrgicos el nivel de profilaxis alcanzado es adecuado, pero hay un porcentaje importante de pacientes médicos con riesgo tromboembólico medio-alto, que sigue sin recibir la adecuada profilaxis (infrautilización), a pesar de las recomendaciones de consenso con amplio respaldo científico y profesional.

Palabras clave:

Prevalencia

Corte transversal

Estudio de utilización de medicamentos

Enfermedad tromboembólica venosa

Profilaxis

Heparinas de bajo peso molecular

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☆

This study was carried out under the research project “Prevention of thromboembolism in medical and surgical patients: assessment of risk and use of low-molecular-weight heparin” funded by the Regional Ministry of Health of the Andalusian Government and the Carlos III Health Institute, with a grant received in the Call for Biomedicine Research grants, the Program for Rational Use of Medication, in the Autonomous Community of Andalusia.

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