Venous thromboembolism risk & prophylaxis in the acute hospital care setting (ENDORSE), a multinational cross-sectional study: Results from the Indian subset data
Ramakrishna Pinjala1, Vinod Agnihotri2, A Balraj3, Amiya Chakraborty4, Sanjay Desai5, Antony Elangovan6, Partha Goswami7, Emmanuel Rupert8, Kedar Toraskar9, Kakollu Venkatesh10
1 Department of Vascular Surgery, Nizam's Institute of Medical Sciences, Hyderabad, India
2 Holy Family Hospital, New Delhi, India
3 Chennai Port Trust Hospital, Chennai, India
4 St John's Medical College Hospital, Bangalore, India
5 MS Ramaiah Hospital, Bangalore, India
6 Southern Railway Hospital, Chennai, India
7 Woodlands Medical Centre Ltd., Kolkata, India
8 Rabindranath Tagore International Institute of Cardiac Science, Kolkata, India
9 Prince Aly Khan Hospital, Mumbai, India
10 Gandhi Hospital, Hyderabad, India
Department of Vascular Surgery, Nizam's Institute of Medical Sciences, Hyderabad 500 082
Source of Support: None, Conflict of Interest: None
Background & objectives: Venous thromboembolism (VTE) is a major health problem with substantial morbidity and mortality. It is often underdiagnosed due to lack of information on VTE risk and prophylaxis. The ENDORSE (Epidemiologic International Day for the Evaluation of Patients at Risk for Venous Thromboembolism in the Acute Hospital Care Setting) study aimed to assess the prevalence of VTE risk in acute hospital care setting and proportion of at-risk patients receiving effective prophylaxis. We present here the risk factor profile and prophylaxis pattern of hospitalized patients who participated in ENDORSE study in India.
Methods: In this cross-sectional study in India, all patients (surgical >18 yr, medical >40 yr) from 10 hospitals were retrospectively studied. Demographics, VTE risk factors and prophylaxis patterns were assessed according to the 2004 American College of Chest Physicians (ACCP) evidence-based consensus guidelines.
Results: We recruited 2058 patients (1110 surgical, 948 medical) from 10 randomly selected hospitals in India between August 2006 and January 2007. According to the ACCP criteria, 1104 (53.6%) patients [surgical 680 (61.3%), medical 424 (44.7%)] were at-risk for VTE. Chronic pulmonary disease/heart failure and complete immobilization were the most common risk factors before and during hospitalization, respectively. In India, 16.3 per cent surgical and 19.1 per cent medical at-risk patients received ACCP-recommended thromboprophylaxis.
Interpretation & conclusions: Despite a similar proportion of at-risk hospitalized patients in India and other participating countries, there was major underutilization of prophylaxis in India. It necessitates increasing awareness about VTE risk and ensuring appropriate thromboprophylaxis.