Pharmacological prophylaxis of venous thromboembolism in adult medical and surgical wards in the Gaza Strip: a multi-centre clinical audit

Background Hospital-acquired venous thromboembolism (VTE) has a reported worldwide prevalence of 0·8–11%. It is the most common cause of preventable death, underlining the importance of VTE prevention. Methods This clinical audit was conducted in adult medical and surgical wards of three hospitals in Gaza, from March to August, 2017. Patients were assessed prospectively using the modified Padua Prediction Score risk assessment model and the Caprini Score to categorise patients as having high or low risk of developing VTE. Approval was obtained from the General Directorate of Human Resources of the Ministry of Health. Findings In total, 300 medical patients were included, with a mean age of 54 years (SD 22 years) and a mean hospital stay of 4 days (SD 2·5 days). Of these patients, 49·7% (149 of 300) had a Modified Padua score of 4 or greater (anticoagulants indicated), of whom 84·6% (126 of 149) received anticoagulants in accordance with guidelines, whereas 15·4% (23 of 149) did not. Of the 50·4% of patients (151 of 300) with a score of less than 4 (anticoagulants not indicated), 64·2% (97 out of 151) had no VTE prophylaxis, whereas 35·8% (54 out of 151) received it without indication. In total, 150 surgical patients were included, with a mean age of 32 years (SD 14·7 years) and a post-operative stay of 3 days (SD 1·5 days). Of these patients, 43·3% (65 of 150) had a Caprini score of greater than 2 (anticoagulants indicated), 69·2% (45 of 65) received anticoagulants in accordance with guidelines, but 30·7% (20 of 65) did not. Of the 56·7% of patients (85 of 150) with a score of 2 or lower (anticoagulants not indicated), 82·3% (70 out of 85) had no VTE prophylaxis, whereas 17·7% (15 out of 85) received it without indication. Interpretation The results reflect poor adherence to current standards of care for VTE prophylaxis, demonstrating that an action plan for appropriate heparin prescription is needed for each hospital. Action plans involving hospital pharmacy departments, multidisciplinary care, good communication within teams, and staff education are underway. A re-audit is planned following this action. Funding None.