Global Risk Profile Verification in Patients with Venous Thromboembolism (GRIP VTE) in 5 Gulf Countries

Abstract

Background: The Global Risk Profile Verification in Patients with Venous Thromboembolism was the first prospective multicenter registry conducted in Arabian Gulf countries to explore the epidemiology of venous thromboembolic (VTE) disorders and to provide data on diagnosis and disease management. Methods: Data on 242 patients with confirmed VTE were submitted between September 2003 and November 2003 from 28 contributing hospitals in the Arabian Gulf region. Differences between groups were assessed by the χ² test or Fisher exact test for categorical variables. The Student's t test was used for testing proportions. Results: The frequency of VTE cases is deep vein thrombosis (DVT), 187 (77.27%); pulmonary embolism (PE), 35 (14.46%); and DVT with PE, 20 (8.26%). The most common symptoms of DVT and DVT/PE patients were calf pain (72%), calf swelling (63.8%), and localized tenderness (52.2%). The most common symptoms in patients with PE alone and DVT/PE were dyspnea (83.6%), thoracic pain (69.1%), and cough (40%). Risk factors for VTE were immobilization (41.3%), age >65 years (28.9%), a history of VTE (20.7%), and trauma (19%). Among surgical interventions, orthopedic procedures induced the greatest number of VTE cases, followed by general surgery and gynecological procedures. Low-molecular-weight heparins were chosen to treat 33.7% of DVT cases, whereas unfractionated heparin was used in 21.9% of cases. Conclusion: VTE remains a common problem in medical and surgical patients in the Arabian Gulf states. Recognition of the common risk factors is of extreme importance to implement the appropriate prophylactic strategy according to the published guidelines.

Keywords

deep vein thrombosis (DVT)pulmonary embolism (PE)venous thromboembolism (VTE)Gulf states

References

Hirsh J. , Hoak J. Management of deep vein thrombosis and pulmonary embolism. A statement for healthcare professionals from the Council on Thrombosis (in consultation with the Council on Cardiovascular Radiology), American Heart Association. Circulation. 1996;93:2212-2245.

Pesavento R. , Lusiani L. , Visonà A. , et al. Prevalence of clinically silent pulmonary embolism in deep vein thrombosis of the legs [in Italian]. Minerva Cardioangiol. 1997;45:369-375.

Girard P. , Musset D. , Parent F. , Maitre S. , Phlippoteau C. , Simonneau G. High prevalence of detectable deep venous thrombosis in patients with acute pulmonary embolism. Chest. 1999;116:903-908.

Goldhaber SZ , Hennekens CH , Evans DA , Newton EC , Godleski JJ Factors associated with correct antemortem diagnosis of major pulmonary embolism. Am J Med. 1982;73:822-826.

Rosendaal FR Risk factors for venous thrombosis: prevalence, risk and interaction. Semin Hematol. 1997; 34:171-187.

Heit JA , O'Fallon WM , Petterson TM , et al. Relative impact of risk factors for deep vein thrombosis and pulmonary embolism: a population-based study. Arch Intern Med. 2002;162:1245-1248.

Seinturier C. , Bosson JL , Colonna M. , Imbert B. , Carpentier PH Site and clinical outcome of deep vein thrombosis of the lower limbs: an epidemiological study. J Thromb Haemost . 2005;3:1362-1367.

Dorfman M. , Chan SB , Maslowski C. Hospital-acquired venous thromboembolism and prophylaxis in an integrated hospital delivery system. J Clin Pharm Ther. 2006;31:455-459.

Henke PK , Ferguson E. , Varma M. , Deatrick KB , Wakefield GT , Woodrum DT Proximate versus nonproximate risk factor associated primary deep venous thrombosis: clinical spectrum and outcomes. J Vasc Surg. 2007;45:998-1003.

10.

Stein PD , Beemath A. , Olson RE Trends in the incidence of pulmonary embolism and deep venous thrombosis in hospitalized patients. Am J Cardiol. 2005;95: 1525-1526.

11.

Goldhaber SZ , Dunn K. , MacDougall BA New onset of venous thromboembolism among hospitalized patients at Brigham and Women's Hospital is caused more often by prophylaxis failure than by withholding treatment. Chest . 2000;118:1680-1684.

12.

Arcelus J. , Caprini J. , Monreal M. , Suarez C. , Gonzalez-Fejardo J. The management and outcome of acute venous thromboembolism: a prospective registry including 4011 patients. J Vasc Surg. 2003;38: 916-922.

13.

Segal JB , Eng J. , Tamariz LJ , Bass EB Review of the evidence on diagnosis of deep venous thrombosis and pulmonary embolism. Ann Fam Med. 2007;5:63-73.

14.

Clagett GP , Anderson FA Jr , Heit J. , Levine MN , Wheeler HB Prevention of venous thromboembolism. Chest. 1995;108(4 suppl.):312S-334S.

15.

Lassen MR , Borris LC Managing the risk of thrombosis in the perioperative period in patients undergoing orthopedic and trauma surgery with low-molecular-weight heparin: enoxaparin . Orthopedics. 1997;20(suppl.):14-17.

16.

Geerts WH , Jay RM , Code KI , et al. A comparison of low-dose heparin with low-molecular-weight heparin as prophylaxis against venous thromboembolism after major trauma. N Engl J Med. 1996;335:701-707.

17.

Demers C. , Marcoux S. , Ginsberg JS , Laroche F. , Cloutier R. , Poulin J. Incidence of venographically proved deep vein thrombosis after knee arthroscopy . Arch Intern Med. 1998;158:47-50.

18.

Eriksson BI , Lassen MR , PENTasaccharide in HIp-FRActure Surgery Plus Investigators. Duration of prophylaxis against venous thromboembolism with fondaparinux after hip fracture surgery: a multicenter, randomized, placebo-controlled, double-blind study. Arch Intern Med. 2003;163:1337-1342.

19.

Dahl OE , Andreassen G. , Aspelin T. , et al. Prolonged thromboprophylaxis following hip replacement surgery: results of a double-blind, prospective, randomized, placebo-controlled study with dalteparin (Fragmin). Thromb Haemost. 1997;77:26-31.

20.

Gibbs NM Venous thrombosis of the lower limbs with particular reference to bed-rest . Br J Surg. 1957;45:209-235.

21.

Warlow C. , Ogston D. , Douglas AS Deep venous thrombosis of the legs after stroke. Br Med J . 1976;1:1178-1181.

22.

Homans J. Thrombosis of the leg veins due to prolonged sitting. N Engl J Med. 1954;250:148-149.

23.

Apostle F. , Surget V. , Borron SW , et al. Severe pulmonary embolism associated with air travel. N Engl J Med. 2001; 345:779-783.

24.

Huerta C. , Johansson S. , Wallander MA , García Rodríguez LA Risk factors and short-term mortality of venous thromboembolism diagnosed in the primary care setting in the United Kingdom. Arch Intern Med. 2007; 167:935-943.

25.

Di Minno G. , Mannucci PM , Tufano A. , et al. The first ambulatory screening on thromboembolism: a multicentre, cross-sectional, observational study on risk factors for venous thromboembolism. J Thromb Haemost. 2005;3: 1459-1466.

26.

Rosendaal FR Thrombosis in the young: epidemiology and risk factors, a focus on venous thrombosis. Thromb Haemost. 1997;78:1-6.

27.

Hansson PO , Sörbo J. , Erikson H. Recurrent venous thromboembolism after deep vein thrombosis: incidence and risk factors. Arch Intern Med. 2000;160:769-774.

28.

Michota F. Venous thromboembolism: epidemiology, characteristics, and consequences. Clin Cornerstone. 2005;7:8-15.

29.

Coiteux I. , Mazzolai L. Deep vein thrombosis: epidemiology, risk factors and natural history [in French] . Schweiz Rundsch Med Prax. 2006;95:455-459.

30.

Koster T. Deep-Vein Thrombosis. A Population-Based Case-Control Study: Leiden Thrombophilia Study [thesis]. Leiden, The Netherlands: Rijksuniversiteit Leiden; 1995.

31.

Geerts WH , Code KI , Jay RM , Chen E. , Szalai JP A prospective study of venous thromboembolism after major trauma. N Engl J Med. 1994;331:1601-1606.

32.

Hull RD , Raskob GE Prophylaxis of venous thromboembolic disease following hip and knee surgery . J Bone Joint Surg. 1986;68:146-150.