Venous thromboembolism-related mortality and morbidity in King Fahd General Hospital, Jeddah, Kingdom of Saudi Arabia

BACKGROUND: Venous thromboembolism (VTE) is a serious and underestimated potentially fatal disease with an effective prophylactic antithrombotic therapy that is usually underused. OBJECTIVES: The primary study objective is to determine the percentage of VTE patients who received prophylactic antithrombotic therapy according to ACCP guidelines. Secondary study objectives are determining prevalence of confirmed VTE mortality among all cause hospital mortalities, measuring adherence to anticoagulation treatment after discharge and number of VTE events among those patients. METHODS: During the period from first of July 2008 till 30 of June 2009, we collected all hospital deaths, all patients with confirmed VTE diagnosis at King Fahd General Hospital, Jeddah, Kingdom of Saudi Arabia. Only patients with confirmed VTE diagnosis were included in the analysis. RESULTS: Five hundred cases with clinical diagnosis of VTE were identified. Out of them 178 were confirmed to be VTE. 36.5% of them received prophylactic antithrombotic therapy. Case fatality rate was 20.8% representing 1.9% of hospital deaths. Case fatality rate was 31% and 3.1% for patients who did not receive thromboprophylaxis and patients who received it, respectively (P < 0.0001). 66.3% and 33.7% of confirmed VTE cases occurred in surgical and medical patients respectively. Only 44.1% of surgical patients and 21.7% of medical patients received prophylaxis (P < 0.01). Case fatality rate is 11% for surgical patients and 40% for medical patients (P < 0.001). Of 141 survived cases, 118 (83.7%) were adherent to anticoagulation therapy after discharge. CONCLUSIONS: VTE prophylaxis guideline is not properly implemented and extremely underutilized. Mortality from VTE is significantly higher in patients who did not receive VTE prophylaxis. In the absence of regular post-mortem practice VTE related mortality rate would be difficult to estimate and likely will be underestimated. Health authorities should enforce VTE prophylaxis guideline within the healthcare system.