Prophylaxis against Deep Venous Thrombosis in Patients Hospitalized in Surgical Wards in One of the Hospitals in Iran: Based on the American College of Chest Physician’s Protocol

Masoumeh Shohani, Akram Mansouri, Siros Norozi, Naser Parizad, Milad Azami


Background: There is not enough studies to determine the frequency of using the prophylaxis against deep venous thrombosis (DVT) based on the American College of Chest Physician’s (ACCP) guidelines in Iran. Thus, providing such statistics is essential to improve thromboprophylaxis in
hospital. The present study aimed to determine the frequency of using the prophylaxis against DVT based on ACCP guidelines in patients hospitalized in surgical wards in one of teaching hospital in Ilam, Iran.

Methods: In a cross‑sectional, the samples were selected among medical records of patients who were hospitalized and underwent surgery in surgical wards of the hospital from April 2012 to September 2013. Type of prophylaxis was determined based on ACCP guidelines. After reviewing inclusion and exclusion criteria, patients’ data were extracted from medical records based on required variables.

Results: In reviewing 169 qualifed samples, 46.2% (78 patients) were women. Of these, 132 patients were at risk of DVT and needed prophylaxis, only 39 patients (29.5%) received prophylaxis. Thromboprophylaxis based on ACCP guidelines had been fully implemented only in 30 cases (22.7%) of patients with the risk of DVT.. The highest thromboprophylaxis was in the intensive care unit (46.6%) and neurosurgery (37.5%), and the least rate was in urology (0%).

Conclusions: As the results of this study, there are differences between clinical practice and the ACCP guidelines recommendation in prophylaxis against DVT. Thromboprophylaxis has not been implemented based on ACCP guidelines in more than 75% of patients with the risk of DVT. Thus, new strategies are needed to implement thromboprophylaxis against DVT in Iranian hospitals.

Keywords: Deep venous thrombosis, prophylaxis, thromboprophylaxis

Full Text:



Geerts WH, Pineo GF, Heit JA, Bergqvist D, Lassen MR,

Colwell CW, et al. Prevention of venous thromboembolism: The

Seventh ACCP Conference on Antithrombotic and Thrombolytic

Therapy. Chest 2004;126 3 Suppl:338S‑400S.

Sharif‑Kashani B, Mohebi‑Nejad A, Abooturabi SM. Estimated

prevalence of venous thromboembolism in Iran: Prophylaxis still

an unmet challenge. Tanaffos 2015;14:27‑33.

Geersing GJ, Zuithoff NP, Kearon C, Anderson DR,

Ten Cate‑Hoek AJ, Elf JL, et al. Exclusion of deep vein

thrombosis using the Wells rule in clinically important subgroups:

Individual patient data meta‑analysis. BMJ 2014;348:g1340.

SooHoo NF, Eagan M, Krenek L, Zingmond DS. Incidence

and factors predicting pulmonary embolism and deep venous

thrombosis following surgical treatment of ankle fractures. Foot

Ankle Surg 2011;17:259‑62.

van Stralen KJ, Rosendaal FR, Doggen CJ. Minor injuries

as a risk factor for venous thrombosis. Arch Intern Med


Ro A, Kageyama N, Fukunaga T. Significance of the soleal vein

for the pathogenesis of deep vein thrombosis leading to acute

massive pulmonary thromboembolism. Masui 2007;56:801‑7.

Safavi E, Zahedpour Anaraki MR, Firoozbakhsh SH,

Nikparvar Fard M. The study of diagnosed venous

thromboembolism. Tanaffos 2003;2:15‑22.

Alikhan R, Bedenis R, Cohen AT. Heparin for the prevention

of venous thromboembolism in acutely ill medical

patients (excluding stroke and myocardial infarction). Cochrane

Database Syst Rev 2014;7:CD003747.

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;110:874‑9.

Boneu B, Caranobe C, Cadroy Y, Dol F, Gabaig AM, Dupouy D,

et al. Pharmacokinetic studies of standard unfractionated heparin,

and low molecular weight heparins in the rabbit. Semin Thromb

Hemost 1988;14:18‑27.

Joint Commission on Accreditation of Healthcare Organizations.

National Consensus Standards for Prevention and Care of

Venous Thromboembolism (VTE); 2007. Available from:

PerformanceMeasurement/VTE.htm. [Last accessed on

Dec 06].

Cohen AT, Tapson VF, Bergmann JF, Goldhaber SZ,

Kakkar AK, Deslandes B, et al. Venous thromboembolism risk

and prophylaxis in the acute hospital care setting (ENDORSE

study): A multinational cross‑sectional study. Lancet


Pinjala R; ENDORSE‑India Investigators. Venous

thromboembolism risk & prophylaxis in the acute hospital

care setting (ENDORSE), a multinational cross‑sectional

study: Results from the Indian subset data. Indian J Med Res


França A, Reis A, Paulino A, Lohman C, Cartucho D,

Campello G, et al. Venous thromboembolism risk factors and

practices of prophylaxis: ENDORSE study results in Portugal.

Acta Med Port 2011;24:951‑60.

Musiał J, Sydor WJ; ENDORSE Investigators‑Poland. Venous

thromboembolism risk and prophylaxis in the acute hospital care setting‑results of the ENDORSE study in Poland. Pol Arch Med

Wewn 2008;118:555‑61.

Amin A, Spyropoulos AC, Dobesh P, Shorr A, Hussein M,

Mozaffari E, et al. Are hospitals delivering appropriate VTE

prevention? The venous thromboembolism study to assess the

rate of thromboprophylaxis (VTE start). J Thromb Thrombolysis


Hoseini Nasab A, Zahmatkesh M. Evaluation the rate of the

preventive measurement for venous thromboembolism in surgical

ward of a private hospital in Tehran. RJMS 2002;9:216‑23.

Khavaninzadeh M, Mousavi Vaeezi S, Ramezaniyan Nik E,

Reza Gharebagh K. Determination of the frequency of

prophylaxis usage against deep‑vein thrombosis in hospitalized

patients admitted in an educational hospital. Razi J Med Sci


Nutescu EA. Assessing, preventing, and treating venous

thromboembolism: Evidence‑based approaches. Am J Health

Syst Pharm 2007;64 11 Suppl 7:S5‑13.

Geerts WH, Heit JA, Clagett GP, Pineo GF, Colwell CW,

Anderson FA, et al. Prevention of venous thromboembolism.

Chest 2001;119:1325‑755.

Leme LE, Sguizzatto GT. Prophylaxis of venous

thromboembolism in orthopaedic surgery. Rev Bras Ortop