CARDIOVASCULAR JOURNAL OF AFRICA • Volume 25, No 4, July/August 2014
AFRICA
163
The proportion of patients at risk for VTE and the use of
ACCP-recommended prophylaxis by country are shown in Fig.
1. The proportion of hospital patients at risk for VTE ranged
among countries from 23 to 66%, and the proportion of at-risk
patients receiving ACCP-recommended prophylaxis ranged from
22 to 80%. The proportion of surgical patients at risk for VTE
ranged among countries from 22 to 73%, and for medical patients
the range was from 26 to 90%. The use of recommended VTE
prophylaxis in surgical patients varied from 25 to 100% between
countries, and for medical patients between 1 and 46% (Fig. 1).
Discussion
The data gathered show a high prevalence of VTE risk among
hospitalised patients in sub-Saharan Africa. More than half
of all hospitalised patients were at risk for VTE, and medical
patients were at higher risk than surgical patients. The data
further show that less than half of all at-risk patients received an
ACCP-recommended method of prophylaxis.
Data from this survey showed that the proportion of hospital
patients at risk for VTE ranged from 23 to 66% and the
proportion of at-risk patients receiving ACCP-recommended
prophylaxis ranged from 22 to 80%. The proportion of surgical
patients at risk for VTE ranged from 22 to 73%, and for medical
patients the range was from 26 to 90%. The use of recommended
VTE prophylaxis in surgical patients varied from 25 to 100%,
and for medical patients between 1 and 46%.
Although there is little information on VTE prevalence and
the rate of usage of VTE prophylaxis in Africa,
22
data from this
survey support data from previous studies that have shown a
similar trend. Studies conducted elsewhere have reported overall
VTE prophylaxis rates ranging from 13 to 64%.
The data showed marked differences between countries
in the frequency of use of ACCP-recommended types of
prophylaxis, which could be due to many factors, including
physician awareness, availability of guidelines, education factors,
reimbursement, and national healthcare resources. The use of
recommended VTE prophylaxis was particularly poor in medical
patients, with prophylaxis received by only 35.1% of medical
patients deemed to be at risk. This finding is consistent with
other studies that have shown low use of prophylaxis in at-risk
medical patients.
12,19
In surgical patients, prophylaxis rates were generally higher.
The increased use of prophylaxis in the surgical setting compared
with the medical setting could result from several factors. First,
the benefits of prophylaxis in the surgical setting have been
Table 6. Risk factors for thromboembolism among
patients during hospitalisation
Risk factor
Number (%) of patients
Surgical
(n
=
1016)
Medical
(n
=
567)
All
patients
(n
=
1583)
Admitted to ICU/UCU
195 (19.2) 31 (5.5) 226 (14.5)
Central venous catheter
26 (2.6)
11 (2.0)
37 (2.5)
Mechanical ventilation
106 (10.5)
–
106 (6.7)
Immobile with bathroom
privileges
400 (39.5) 280 (49.3) 680 (43.1)
Complete immobilisation
571 (56.3) 132 (23.3) 703 (44.4)
Cancer therapy
20 (1.9)
9 (1.6)
29 (1.8)
Heparin-induced thrombo-
cytopenia
–
–
–
Table 7. Contra-indications to anticoagulant prophylaxis
Risk factor
Number (%) of patients
Surgical
(
n
=
1016)
Medical
(
n
=
567)
All
patients
(
n
=
1583)
Significant renal impairment
19 (1.9)
88 (15.5) 107 (6.8)
Active gastro-duodenal ulcer
8 (0.8)
8 (1.4)
16 (1.0)
Intracranial haemorrhage
12 (1.2)
14 (2.5)
26 (1.6)
Aspirin on admission
21 (2.1)
57 (10.0)
78 (4.9)
Low platelet count
6 (0.6)
21 (3.7)
27 (1.7)
Known bleeding disorder
1 (0.1)
4 (0.7)
5 (0.3)
Hepatic impairment
7 (0.7)
17 (3.0)
24 (1.5)
NSAID on admission (excluding
aspirin)
191 (18.8) 31(5.5) 222 (14.0)
Bleeding at hospital admission 63 (6.2)
14 (2.5)
77 (4.9)
Table 8. ACCP-recommended prophylaxis to VTE received
Type of prophylaxis
Number (%) of patients
Surgical
(
n
=
1016)
Medical
(
n
=
567)
All
patients
(
n
=
1583)
Low-molecular weight heparin
506 (49.9) 132 (23.1) 638 (40.2)
Unfractionated heparin
5 (0.5)
11 (2.0)
16 (1.2)
Vitamin K antagonist
7 (0.7)
4 (0.8)
11 (0.8
Fondaparinux
–
–
–
Other anticoagulants
2 (0.2)
–
2 (0.1)
Foot pump
12 (1.2)
–
12 (2.0)
Graduated compression
stockings
54 (5.3)
–
54 (3.4)
Intermittent pneumatic
compression
–
–
–
180
160
140
120
100
80
60
40
20
0
Botswana Cameroon DR Congo Madagascar Nigeria
Country
At risk for VTE
– surgical
At risk for VTE
– medical
Received prophylaxis
– surgical
Received prophylaxis
– surgical
Number of patients
Fig. 1.
Percentage at-risk patients versus patients that
received ACCP-recommended VTE prophylaxis by
country.
