Assessment of the Heparin and Enoxaparin Prophylaxis Protocol in Patients Receiving Care at Sina Hospital in Tabriz

Mahsa Seifi  Mansour; Hamid  Noshad; Soheil  Teimouri; Nasim  Nourani; Afshin  Gharekhani

doi:10.18502/acta.v63i4.20166

Mahsa Seifi Mansour Student Research Committee, Factulty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
Hamid Noshad Kidney Research Center, Sina Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
Soheil Teimouri Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
Nasim Nourani Department of Community Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
Afshin Gharekhani Pharmaceutical Analysis Research Center, Tabriz University of Medical Sciences, Tabriz,

DOI: https://doi.org/10.18502/acta.v63i4.20166

Keywords: Anticoagulants; Drug utilization review; Enoxaparin; Heparin; Venous thromboembolism

Abstract

Abstract- Venous thromboembolism (VTE) poses a significant risk to hospitalized patients, accounting for approximately 10% of morbidity cases among this population. However, preventive measures such as heparin and low molecular weight heparin (LMWH), along with mechanical interventions like graduated compression stockings (GCS), can effectively mitigate this risk. The aim of this study was to investigate the rational use of DVT prophylaxis regimen in hospitalized patients. A prospective and descriptive study was conducted randomly in various wards of the hospital throughout 2017. 335 participants were randomly assessed using an already designed questionnaire containing demographic information (age, weight, height, etc.), medical history, type of prophylaxis administered, laboratory tests, prescribed medications, the Geneva score for thrombosis risk evaluation (low risk: 0-2, high risk: ≥3), and bleeding risk assessment tool (low risk: 0-7, high risk: ≥7). Randomly, the medical records of 335 patients admitted to Sina Hospital and who received VTE prophylaxis with heparin (87.8%), enoxaparin (12.54%), and GCS (1.79%), were carefully reviewed over a period of 12 months. According to the guidelines, only 235 patients (70.1%) required anticoagulant prophylaxis, while the remaining 100 patients (29.8%) were not eligible for such prophylaxis. Additionally, out of the 335 patients studied, only 6 received GCS, although only one patient actually necessitated this intervention. Consequently, the total cost of inappropriate anticoagulant prophylaxis was estimated to be 68,270,500 Rials. The appropriate utilization rate of VTE prophylaxis was 70.1%, with heparin being the most commonly prescribed medication. Further, the study highlights the cost implications of inappropriate prescription practices. To address these issues, educational programs and the implementation of clinical practice guidelines within general Hospitals are highly recommended.