Venous Thromboembolism Risk, Prophylaxis and Incidence among Patients attending Emergency Department of Tertiary Care Hospitals in Addis Ababa Ethiopia: A Multicenter Prospective Study
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Date
2024-06
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Addis Ababa University
Abstract
Background: Venous Thromboembolism (VTE) constitutes pulmonary embolism and deep vein
thrombosis. This problem is a major public issue associated with significant morbidity and mortality.
There is initial evidence suggesting that early recognition of acute VTE and the nonspecificity of its
symptoms and signs, however, there was a paucity of data to follow the guidelines for accurate risk
assessment and tailored pharmacological thromboprophylaxis.
Objective: To assess VTE risk, prophylaxis, incidence and its predictors among patients attending the
emergency department (ED) of tertiary hospitals in Addis Ababa Ethiopia.
Method: A multicenter hospital-based prospective study was conducted from June 1 to September 15/
2023 in patients admitted to the adult ED of the three tertiary care hospitals namely Tikur Anbesa
Specialized Hospital, St Paulos Hospital Millennium Medical College and Addis Ababa Burn
Emergency and Trauma (AaBET) Hospital. The data was collected using questionnaire prepared by
reviewing different literature and the Padua VTE risk assessment tool. The collected data was entered
into Epidata version 4.2 then exported to SPSS version 25 for analysis. Multivariable Cox regression
was performed to identify independent predictors for VTE occurrence. Adjusted hazard ratio was used
to measure the strength of association. The P< 0.05 was considered as statistically significant.
Result: A total of 422 patients were enrolled. About 70.64% of ED admitted patients were found to be
in high risk of developing VTE according to Padua risk prediction score. Of eligible patients for
pharmacological prophylaxis only 33.4% of them were given anticoagulant prophylaxis.VTE occurred
in 18 (4.3%) patients after admitted in ED. The multivariable Cox regression analysis showed that the
physically active patients prior to ED admission was less risk to develop VTE compared to physically
inactive patients (Adjusted Hazard Ratio (AHR)= 0.67, 95% (CI): 0.082-1.579, P=0.014),getting
pharmacological prophylaxis decreased the risk of developing VTE by 83% (AHR)=0.167, 95% (CI):
0.037-0.768, P=0.021), having acute infection such as sepsis increased the risk of developing VTE 8
fold than without infection(AHR=8.169, 95%CI: 1.045-63.854, P=0.045) and having active cancer
(AHR=5.133, 95%CI: 1.241-21.093, P=0.023),) were independently associated with VTE event during
follow up period.
Conclusion: The VTE risk and occurrence was high among ED attaining adult patients and the rate of
thromboprophylaxis use for those high-risk patients was low. Absence of pharmacological prophylaxis,
physically inactive patients prior to admission, active cancer and acute infection were found to be
independent predictors for the occurrence of VTE during the emergency ward stay.
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Keywords
VTE Risk, VTE prophylaxis, Emergency Department, Padua Score