CARDIOVASCULAR JOURNAL OF AFRICA • Volume 25, No 4, July/August 2014
164
AFRICA
accepted for many years,
16
while trials in medical patients have
been more recent and physician awareness of VTE risk is lower
in this population.
1
Second, assessment of VTE risk in surgical
patients is simpler than in medical patients, the principal criterion
being the type of surgery rather than a range of illnesses and risk
factors as presented in medical patients.
Conclusion
While venous thromboembolism is a well-recognised condition
in clinical practice in the developed world, with event rates of at
least two to three million per year, little attention is paid to this
threat in the developing world where the burden of infectious
diseases and limited access to healthcare have not recognised
VTE as a significant cause of morbidity and mortality. VTE is
a major public health issue. It is an easily preventable disease
with a substantial risk of morbidity and mortality in patients
hospitalised for acute medical and surgical illnesses.
Data from this survey show that in sub-Saharan African,
as elsewhere in the world, a large proportion of hospitalised
patients are at risk for VTE, and that recommended VTE
prophylaxis is underused. Data from this survey are important
in providing an overview of the magnitude of VTE prevalence
in Africa and the gaps that exist in the prophylaxis of VTE in
at-risk patients in hospital settings.
This study was sponsored by Sanofi.
References
1.
Anderson FA Jr, Wheeler HB, Goldberg RJ, Hosmer DW, Patwardhan
NA, Jovanovic B,
et al
. A population-based perspective of the hospital
incidence and case-fatality rates of deep vein thrombosis and pulmo-
nary embolism. The Worcester DVT Study.
Arch Intern Med
1991;
151
:
933–938.
2.
Heit JA, O’Fallon WM, Petterson TM, Lohse CM, Silverstein MD,
Mohr DN, Melton LJ 3rd. Relative impact of risk factors for deep vein
thrombosis and pulmonary embolism: a population-based study.
Arch
Intern Med
2002;
162
: 1245–1248.
3.
Samama MM, Cohen AT, Darmon J-Y, Desjardins L, Eldor A, Janbon
C,
et al
. A comparison of enoxaparin with placebo for the prevention
of venous thromboembolism in acutely ill medical patients. Prophylaxis
in Medical Patients with Enoxaparin study group.
N Engl J Med
1999;
341
: 793–800.
4.
Leizorovicz A, Cohen AT, Turpie AG, Olsson CG, Vaitkus PT,
Goldhaber SZ; PREVENT Medical Thromboprophylaxis study group.
Randomized, placebo-controlled trial of dalteparin for the prevention
of venous thromboembolism in acutely ill medical patients.
Circulation
2004;
110
: 874–879.
5.
Cohen AT, Davidson BL, Gallus AS, Lassen MR, Tomkowski W, Turpie
AGG,
et al
. Fondaparinux for the prevention of VTE in acutely ill medi-
cal patients.
Blood
2003;
102
: abstract 42.
6.
Geerts WH, Pineo GF, Heit JA, Bergqvist D, Lassen MR, Colwell CW,
Ray JG. Prevention of venous thromboembolism: the Seventh ACCP
Conference on Antithrombotic and Thrombolytic Therapy.
Chest
2004;
126
(3 Suppl): 338S–400S.
7.
Nicolaides AN, Breddin HK, Fareed J, Goldhaber S, Haas S, Hull R,
et al
; Cardiovascular Disease Educational and Research Trust and the
International Union of Angiology. Prevention of venous thromboem-
bolism. International Consensus Statement. Guidelines compiled in
accordance with the scientific evidence.
Int Angiol
2001;
20
: 1–37.
8.
Ageno W, Squizzato A, Ambrosini F, Dentali F, Marchesi C, Mera V,
et
al
. Thrombosis prophylaxis in medical patients: a retrospective review of
clinical practice patterns.
Haematologica
2002;
87
: 746–750.
9.
Ahmad HA, Geissler A, MacLellan DG. Deep venous thrombosis
prophylaxis: are guidelines being followed?
Austr NZ J Surg
2002;
72
:
331–334.
10. Bergmann J-F, Mouly S. Thromboprophylaxis in medical patients: focus
on France.
Semin Thromb Hemost
2002;
28
(Suppl 3): 51–55.
11. Goldhaber SZ, Tapson VF; DVT FREE steering committee. A prospec-
tive registry of 5,451 patients with ultrasound-confirmed deep vein
thrombosis.
Am J Cardiol
2004;
93
: 259–262.
12. Mismetti P, Laporte-Simitsidis S, Tardy B, Cucherat M, Buchmuller A,
Juillard-Delsart D, Decousus H. Prevention of venous thromboembo-
lism in internal medicine with unfractionated heparin or low-molecular-
weight heparins: a meta-analysis of randomized clinical trials.
Thromb
Haemost
2000;
83
: 14–19.
13. Alikhan R, Cohen AT. A safety analysis of thromboprophylaxis in acute
medical illness.
Thromb Haemost
2003;
89
: 590–591.
14. Arnold DM, Kahn SR, Shrier I. Missed opportunities for prevention of
venous thromboembolism: an evaluation of the use of thromboprophy-
laxis guidelines.
Chest
2001;
120
: 1964–1971.
15. Learhinan ER, Alderman CP. Venous thromboembolism prophylaxis
in a South Australian teaching hospital.
Ann Pharmacother
2003;
37
:
1398–1402.
16. Burns PJ, Wilsom RG, Cunningham C. Venous thromboembolism
prophylaxis used by consultant general surgeons in Scotland.
J R Coll
Surg Edinb
2001;
46
: 329–333.
17. Caiafa JS, de Bastos M, Moura LK, Raymundo S; Brazilian registry of
venous thromboembolism prophylaxis. Managing venous thromboem-
bolism in Latin American patients: emerging results from the Brazilian
registry.
Semin Thromb Hemost
2002;
28
(Suppl 3): 47–50.
18. Kucher N, Koo S, Quiroz R, Cooper JM, Paterno MD, Soukonnikov B,
Goldhaber SZ. Electronic alerts to prevent venous thromboembolism
among hospitalized patients.
N Engl J Med
2005;
352
: 969–977.
19. Kakkar AK, Davidson BL, Haas SK; the Investigators Against
Thromboembolism (INATE) core group. Compliance with recom-
mended prophylaxis for venous thromboembolism: improving the use
and rate of uptake of clinical practice guidelines.
J Thromb Haemost
2004;
2
: 221–227.
20. Vallano A, Arnau JM, Miralda GP, Perez-Bartoli J. Use of venous
thromboprophylaxis and adherence to guideline recommendations: a
cross-sectional study.
Thromb J
2004;
2
: 3.
21. Cohen A,
et al.
Venous thromboembolism risk and prophylaxis in the
acute hospital care setting (ENDORSE study): a multinational cross-
sectional study. Lancet 2008;
371
: 387–394.
22. Duncan A. The case for venous thromboembolism prophylaxis in
Africa.
East Afr Med J
2009:
86
(12 Suppl): S108–109.
