The present study screened 705 patients from 40 sites across Lebanon and Jordan. Of them, 704 patients (400 from Jordan and 304 from Lebanon) (99.9%) were eligible for final analysis and one patient (0.1%) was excluded as the weight was above 100 kg. Regarding the demographic characteristics of the included patients, the patients’ age ranged from 18 to 93 years with a mean age of 54.9 ±17.5 years. Almost 48% of the patients were males. The mean weight and height of the included patients were 75.7 ±13.4 kg and 165.9 ±9.3 cm, respectively. The BMI of the included patients ranged from 16.1 to 44.2 kg/m2 with a mean BMI of 27.5 ±4.8 kg/m2. In terms of vital signs, the mean SBP and DBP of the included patients were 124.1 ±15.4 and 73.8 ±9.7 mmHg, respectively. Sixty percent of the patients had one or more current medical conditions. The most commonly encountered medical condition was hypertension (34.8%), followed by diabetes mellitus (22.6%) and coronary artery disease (10.1%). Two-hundred and forty-six (34.9%) patients were admitted for medical causes only, 449 (63.8%) patients were admitted for surgical causes only, and 9 (1.3%) patients were admitted for both medical and surgical causes. The average hospital stay of the included patients was 5.8 ±8.4 days. The Demographic and clinical characteristics of the included patients were summarized in Table 1.
Six hundred and sixteen patients (87.5%) had one or more risk factors for VTE which were either surgical (55.5%), medical (31.4%), or surgical and medical risk factors (0.6%). Sixty patients (8.5%) had risk factors associated with increased bleeding such as active bleeding (1.1%) and low platelet count. In addition, 25 (3.5%) patients had risk factors associated with mechanical prophylaxis which were severe peripheral arterial disease (0.4%), congestive heart failure (2.8%), and acute superficial/deep vein thrombosis (0.3%).
Among the 704 patients who were eligible for the final analysis, 415 (58.9%) patients received prophylaxis treatment in form of pharmacological anticoagulant prophylaxis (n=371, 52.7%), mechanical prophylaxis (n=13, 1.8%), and pharmacological plus mechanical prophylaxis (n=31, 4.4%). LMWH was the most commonly used anticoagulant for VTE prophylaxis (n=366); however, the unfractionated heparin was administrated in 56 patients only as seen in Table 2. In Lebanon as well as Jordan, LMWH was the most commonly used anticoagulant for VTE prophylaxis (N=192, 48%) and (N=174, 57.2%), respectively (Table 3).
Among surgical patients who received anticoagulants (N =233), 59.2% of them received the drug preoperatively and 40.3% received it postoperatively. Only 6.3% of the patients received mechanical prophylaxis in the form of graduated compression stockings or intermittent pneumatic compression. Almost 31% of the patients continued anticoagulants treatment after discharge in the form of LMWH (85.9%), aspirin (10.2%), warfarin (3.1%), and Fondaparinux (0.8%).
Among the total 704 eligible patients, 415 (58.9%) patients received VTE prophylaxis, while 289 (41.1%) did not receive prophylaxis. For those who received VTE prophylactic treatment, 216 (52%, 95% CI [47.1% - 56.9%) received appropriate prophylactic agents according to ACCP guidelines. For those who were not treated with prophylactic agents, 212 (73.4%, 95% CI [67.9% – 78.4%) were eligible for VTE prophylaxis according to ACCP guidelines as presented in Table 4.
About 60.9% (95% CI 51.9 - 69.4%) of the patients (n=78) received VTE prophylaxis out of the medical patients who were eligible for prophylaxis according to ACCP 2016 guideline (n=128). While in surgical patients, only 45.1% (95% CI 39.3% - 51%) of the patients (n=133) received VTE prophylaxis out of those who were eligible for prophylaxis (n=295), Figure 1. All patients with combined medical and surgical conditions received appropriate prophylaxis.
Regarding the orthopedic surgery, most of the patients received appropriate VTE prophylaxis according to ACCP 2016 guideline. While in non-orthopedic surgery, the number of patients who received appropriate VTE prophylaxis (N=170) was lower than the number of patients who were eligible for prophylaxis (N=227) as seen in Figure 2.
The supplementary file no.2 shows the distribution of appropriate VTE prophylaxis according to doctors’ specialty and the type of surgery.
Overall, the rate of compliance to ACCP guidelines was higher in private hospitals than in public hospitals (85% versus 57.8%, respectively). The rate of compliance to ACCP guidelines was higher among oncologists (73.3%) and general family specialists (72%) than other specialized doctors. The rate of compliance was higher among cases of orthopedic surgeries (100%) and oncological surgeries (79%) than other types of surgery as presented in Table 5.
The multivariate logistic regression analysis showed that only age was a significant predictor of appropriate VTE prophylaxis in the present study (OR 1.05, 95% CI [1.04 – 1.07], P <0.001) (Table 6).