Editorial comment
Venous thromboembolism in Portuguese hospitals: Where we stand and how we can improve
Tromboembolismo venoso nos hospitais portugueses: ponto da situação e como podemos melhorar
Graça Castro
Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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array:3 [ "nombre" => "Graça" "apellidos" => "Castro" "email" => array:1 [ 0 => "castro2406@gmail.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Tromboembolismo venoso nos hospitais portugueses: ponto da situação e como podemos melhorar" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The fact that venous thromboembolism (VTE) is a common cardiovascular disease, particularly among hospitalized patients, with high mortality and morbidity, makes it a major public health issue. The good news is that it is the leading preventable cause of in-hospital death.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Recent years have seen great improvements in all aspects of VTE: prevention, diagnosis and therapy.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> Aspects of VTE prevention such as identification of patients at risk and effective implementation of preventive measures probably remain the most challenging issues in this field.</p><p id="par0015" class="elsevierStylePara elsevierViewall">For the first time in Portugal a prospective study – the ARTE study<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> – has gathered solid and valuable information regarding VTE risk profiles and the use of prophylactic measures in hospitalized patients.</p><p id="par0020" class="elsevierStylePara elsevierViewall">A new risk score derived from the well-known scores of Caprini<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> and Khorana et al.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a> was applied to a population of 4090 hospitalized patients in medical, surgical, orthopedic and oncology departments. The proposed score is designed to be applied to all types of hospitalized patients. This is a clear advantage over the standard scores, especially considering the increasing complexity of diseases. However, it should be validated by prospective and independent studies before it can be used in clinical practice.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The majority of this population (95%) were found to be at high or moderate risk for VTE. Prophylaxis was used in only 67% during hospital stay and in 29% after discharge.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Differences in population characteristics preclude direct comparisons between studies, but these findings are similar to those of the ENDORSE study,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a> which found similar VTE risk profiles between countries but major asymmetries in the use of recommended prophylaxis.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The small number of thrombotic events reported in the ARTE study may reflect underdiagnosis. Major bleeding complications occurred in only 3.9% of inpatients under anticoagulant prophylaxis, reflecting the safety of this approach.</p><p id="par0040" class="elsevierStylePara elsevierViewall">More important is the fact that the majority of VTE events occurred after hospital discharge, probably as a result of inadequate prophylactic measures. This finding is consistent with the need for extended VTE prophylaxis, a subject now under investigation, with several studies indicating a potential benefit.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">6,7</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Prophylaxis rules were underused in the ARTE study, clearly illustrating the need for dissemination and implementation of guideline protocols. There are various possible ways of improving compliance with guidelines, including the use of electronic tools incorporating clinical prediction rules and risk scores.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The publication of the ARTE study in the current issue of the <span class="elsevierStyleItalic">Journal</span> is a valuable contribution to extending knowledge of this condition and has the potential to draw attention to the problem of VTE prophylaxis in Portugal.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Venous thromboembolism: past, present and future" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. 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| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 8 | 3 | 11 |
| 2024 Outubro | 37 | 26 | 63 |
| 2024 Setembro | 47 | 24 | 71 |
| 2024 Agosto | 39 | 31 | 70 |
| 2024 Julho | 37 | 26 | 63 |
| 2024 Junho | 25 | 17 | 42 |
| 2024 Maio | 41 | 16 | 57 |
| 2024 Abril | 33 | 35 | 68 |
| 2024 Maro | 32 | 17 | 49 |
| 2024 Fevereiro | 25 | 21 | 46 |
| 2024 Janeiro | 27 | 24 | 51 |
| 2023 Dezembro | 24 | 20 | 44 |
| 2023 Novembro | 39 | 31 | 70 |
| 2023 Outubro | 23 | 14 | 37 |
| 2023 Setembro | 25 | 21 | 46 |
| 2023 Agosto | 34 | 18 | 52 |
| 2023 Julho | 26 | 11 | 37 |
| 2023 Junho | 28 | 11 | 39 |
| 2023 Maio | 34 | 22 | 56 |
| 2023 Abril | 17 | 2 | 19 |
| 2023 Maro | 27 | 21 | 48 |
| 2023 Fevereiro | 22 | 22 | 44 |
| 2023 Janeiro | 13 | 13 | 26 |
| 2022 Dezembro | 24 | 18 | 42 |
| 2022 Novembro | 35 | 31 | 66 |
| 2022 Outubro | 39 | 31 | 70 |
| 2022 Setembro | 24 | 45 | 69 |
| 2022 Agosto | 21 | 35 | 56 |
| 2022 Julho | 29 | 43 | 72 |
| 2022 Junho | 26 | 34 | 60 |
| 2022 Maio | 16 | 25 | 41 |
| 2022 Abril | 37 | 28 | 65 |
| 2022 Maro | 26 | 47 | 73 |
| 2022 Fevereiro | 16 | 37 | 53 |
| 2022 Janeiro | 26 | 21 | 47 |
| 2021 Dezembro | 16 | 40 | 56 |
| 2021 Novembro | 27 | 33 | 60 |
| 2021 Outubro | 34 | 48 | 82 |
| 2021 Setembro | 23 | 30 | 53 |
| 2021 Agosto | 34 | 33 | 67 |
| 2021 Julho | 15 | 27 | 42 |
| 2021 Junho | 23 | 24 | 47 |
| 2021 Maio | 35 | 37 | 72 |
| 2021 Abril | 31 | 38 | 69 |
| 2021 Maro | 59 | 17 | 76 |
| 2021 Fevereiro | 66 | 17 | 83 |
| 2021 Janeiro | 28 | 12 | 40 |
| 2020 Dezembro | 23 | 15 | 38 |
| 2020 Novembro | 27 | 11 | 38 |
| 2020 Outubro | 26 | 9 | 35 |
| 2020 Setembro | 18 | 10 | 28 |
| 2020 Agosto | 17 | 5 | 22 |
| 2020 Julho | 62 | 13 | 75 |
| 2020 Junho | 23 | 9 | 32 |
| 2020 Maio | 17 | 9 | 26 |
| 2020 Abril | 20 | 16 | 36 |
| 2020 Maro | 17 | 12 | 29 |
| 2020 Fevereiro | 40 | 18 | 58 |
| 2020 Janeiro | 17 | 9 | 26 |
| 2019 Dezembro | 17 | 9 | 26 |
| 2019 Novembro | 33 | 11 | 44 |
| 2019 Outubro | 13 | 5 | 18 |
| 2019 Setembro | 15 | 3 | 18 |
| 2019 Agosto | 13 | 9 | 22 |
| 2019 Julho | 24 | 9 | 33 |
| 2019 Junho | 27 | 18 | 45 |
| 2019 Maio | 19 | 16 | 35 |
| 2019 Abril | 13 | 14 | 27 |
| 2019 Maro | 65 | 11 | 76 |
| 2019 Fevereiro | 42 | 12 | 54 |
| 2019 Janeiro | 17 | 5 | 22 |
| 2018 Dezembro | 39 | 12 | 51 |
| 2018 Novembro | 20 | 6 | 26 |
| 2018 Outubro | 49 | 22 | 71 |
| 2018 Setembro | 27 | 11 | 38 |
| 2018 Agosto | 21 | 13 | 34 |
| 2018 Julho | 6 | 4 | 10 |
| 2018 Junho | 23 | 10 | 33 |
| 2018 Maio | 17 | 9 | 26 |
| 2018 Abril | 30 | 13 | 43 |
| 2018 Maro | 34 | 9 | 43 |
| 2018 Fevereiro | 22 | 4 | 26 |
| 2018 Janeiro | 29 | 13 | 42 |
| 2017 Dezembro | 56 | 36 | 92 |
| 2017 Novembro | 1 | 11 | 12 |
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