Worcester, Massachusetts (ots/PRNewswire)
- ENDORSE Global Findings Highlight the Need to Urgently Implement
Hospital-Wide Strategies to Optimize VTE Management: Systematically
Assess Patient Risk for VTE and Provide Appropriate prophylaxis to
Venous thromboembolism (VTE) risk is high among hospital patients
and most of these at-risk patients are not protected with adequate
prophylaxis according to data from the international ENDORSE
(Epidemiologic International Day for the Evaluation of Patients at
Risk for Venous Thromboembolism in the Acute Hospital Care Setting)
study presented today at the XXIst International Society on
Thrombosis and Haemostasis (ISTH) congress in Geneva.
VTE is a preventable disease which contributes significantly to
morbidity and mortality among patients hospitalized for acute medical
and surgical illnesses. Many complications and deaths due to VTE
could be prevented using thromboprophylaxis as recommended by
evidence based guidelines, but some studies have shown that there is
a gap between evidence and practice in the hospital setting. Lack of
awareness and uncertainty about the prevalence of patients at risk
for VTE are among the major reasons accounting for this gap (1, 2).
To date, there has been no large international study performed in
hospitals selected at random around the world to evaluate VTE risk
and prophylaxis practice globally.
ENDORSE collected data on more than 60,000 patients who were
surveyed across 358 acute care hospitals randomly selected in 32
countries, encompassing 5 continents. All participating hospitals
followed the same standard multinational protocol to survey the
patients present in the wards.
The main objectives of ENDORSE were to assess the prevalence of
VTE risk in the acute hospital care setting and to determine the
proportion of at-risk patients who receive recommended prophylaxis
using the definition of patients at risk of VTE and prophylaxis
recommendations provided by the American College of Chest Physicians
(ACCP) evidence-based consensus guidelines (3). The study included
two categories of hospitalized patients: patients in medical wards 40
years of age or older, and patients in surgical wards, 18 years or
Doctor Fred Anderson, Director of the Center for Outcomes Research
at the University of Massachusetts Medical School who conducted the
study commented "ENDORSE is the first study to provide a global view
of VTE risk and prophylaxis practices throughout the world. With more
than 60,000 patients studied in more than 30 countries, the scope of
ENDORSE is unprecedented. In view of the quality of the data
collected and a common method to assess patients at risk for VTE and
prophylaxis used, this study gives us a unique picture both globally
and locally about the extent of the hospitalized patient population
at risk for VTE and how these patients are managed."
ENDORSE demonstrates the high prevalence of patients at risk for
VTE: 52% of hospitalized patients surveyed were at risk for VTE,
corresponding to 64% of surgical patients and 42% of medical
patients. The prevalence of patients at risk was consistent across
the countries surveyed, demonstrating the importance of VTE risk on a
Importantly, when considering the use of recommended prophylaxis
in hospitals, only 50% of hospitalized patients at risk for VTE
received a method of prophylaxis recommended by the ACCP,
corresponding to 59% of surgical and 40% of medical patients at risk
for VTE. The use of recommended prophylaxis varied across countries;
however, it was globally sub-optimal and even more so in medical than
surgical patients, as the majority of medical patients at risk for
VTE (60%) did not receive recommended prophylaxis.
As highlighted by Doctor Victor Tapson, Co-chair of the ENDORSE
Steering Committee: "ENDORSE clearly shows that VTE is a critical
safety issue in hospitalized patients, as the majority of them are at
risk for VTE. This is really a global concern as a high proportion of
patients at risk for VTE is observed across all the countries
surveyed. Importantly, ENDORSE showed that one out of 2 hospitalized
patients at risk for VTE were not receiving any recommended form of
prophylaxis. It definitely shows that there is globally a sub-optimal
use of VTE prophylaxis and this is even more pronounced among
medically ill patients."
Commenting on the study, Doctor Ander Cohen, Co-chair of the
ENDORSE Steering Committee, said "ENDORSE findings provide strong
evidence of the need to increase awareness about the high prevalence
of VTE risk among hospitalised medical and surgical patients.
Importantly, it highlights the need to significantly improve the use
of appropriate prophylaxis in patients at risk for VTE. In the United
States for instance, VTE prophylaxis has been identified as the
number #1 strategy to improve patient safety in the hospital. If we
want to improve hospital patient outcomes, we urgently need to
implement hospital-wide strategies to identify all surgical and
medical patients at risk for VTE and provide appropriate prophylaxis
to prevent VTE."
About venous thromboembolism (VTE)
Venous thromboembolism is a general term used to describe the
formation of a blood clot (thrombus) that blocks a vein. This may
occur in any part of the venous system, but the most common
manifestations are deep-vein thrombosis (DVT), usually in the leg,
and pulmonary embolism (PE).
VTE is a common complication among patients hospitalized for major
surgery or with a severe medical illness such as cancer or
cardiopulmonary disease, particularly when accompanied by prolonged
bed rest, age over 60, or a previous history of VTE.
About COR (Center for Outcomes Research)
The Center for Outcomes Research (COR) serves as the scientific
coordinating center for a growing number of national and
international outcomes registries. COR's responsibilities include
maintaining patient and physician confidentiality, design of data
collection instruments, data management and publication development.
Established in 1994, COR is an outgrowth of the Worcester Deep
Vein Thrombosis Study, a five-year NIH-supported program, which
demonstrated that physicians are more likely to improve patient
management practices if they are provided with valid data on their
own practices and outcomes along with regional and national
About the University of Massachusetts Medical School
The University of Massachusetts Medical School, one of the fastest
growing academic health centers in the country, has built a
reputation as a world-class research institution, consistently
producing noteworthy advances in clinical and basic research. The
Medical School attracts more than US$174 million in research funding
annually, 80 percent of which comes from federal funding sources. For
more information, visit www.umassmed.edu
ENDORSE study funding
The Center for Outcomes Research (COR) at the University of
Massachusetts Medical School received an unrestricted grant from
sanofi-aventis to support this work.
1. Goldhaber SZ, Tapson VF. Am J Cardiol. 2004;93:259-62.
2. Anderson FA Jr, et al. Blood. 2003;102 [abstract 1146].
3. Geerts WH, Pineo GF, Heit JA, et al. Prevention of venous
thromboembolism: the seventh ACCP conference on Antithrombotic and
Thrombotic Therapy. Chest. 2004;126:338S-400S.
ots Originaltext: University of Massachusetts Medical School
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