[Thromboembolic risk and prophylaxis in hospitalized surgical and internal medicine patients. German results of the international ENDORSE study]

Abstract

BACKGROUND AND OBJECTIVES: Venous thromboembolism (VTE) leads to an increased morbidity in hospitalized patients. This multinational cross-sectional survey was designed to assess the prevalence of VTE risk factors and to determine the proportion of at-risk patients who receive effective VTE-prophylaxis. The results of the 16 participating German hospitals of the study are presented and compared with the international results. PATIENTS AND METHODS: All hospital inpatients aged >or= 40 years admitted to a medical ward and all surgical inpatients aged >or= 18 years were enrolled. The American College of Chest Physicians (ACCP) guidelines (2004) were applied to assess VTE risk and to determine whether patients were receiving recommended VTE prophylaxis. RESULTS: Overall, 2,370 patients were enrolled: 1,210 (51 %) were categorised as surgical and 1,160 (49 %) as acute medically ill. 838 (69 %) of surgical and 479 (41 %) of medical patients were judged to be at risk for VTE. Of the surgical patients at risk, 772 (92 %) received ACCP-recommended VTE prophylaxis, compared with 337 (70 %) medical patients at risk of VTE. Low-molecular weight heparins were most frequently used. CONCLUSIONS: In total, in comparison to other countries, Germany has a leading position in the implementation of international guidelines with regard to VTE prophylaxis. Whereas in a surgical ward effective VTE prophylaxis is consistently standard care, in the medical indications there is still room for improvement in terms of stratification of VTE risk and corresponding VTE-prophylaxis.