ENDORSE Global Findings Highlight the Need to Urgently Implement
Hospital-Wide Strategies to Optimize VTE Management: Systematically
Assess Patient Risk for VTE and Provide Appropriate Prophylaxis to
WORCESTER, MA, Jan. 31 /CNW/ - ENDORSE multinational study (Epidemiologic
International Day for the Evaluation of Patients at Risk for Venous
Thromboembolism in the Acute Hospital Care Setting) published today in the
LANCET(1) demonstrates the high prevalence of patients at risk for VTE
(according to the ACCP guidelines) in the world: 52% of hospitalized patients
surveyed were at risk for VTE, corresponding to 64% of surgical patients and
42% of medical patients.
ENDORSE demonstrates as well, that recommended prophylaxis is only
prescribed to 50% of at-risk patients throughout the world, corresponding to
59% of surgical and 40% of medical patients.
With more than 60,000 patients studied in more than 32 countries
encompassing 6 continents the scope of ENDORSE is unprecedented. With a wide
range of racial, social, economic and health care environment, ENDORSE gives a
unique global and local picture about the extent of the hospitalized patient
population at risk for VTE and how these patients are managed.
Doctor Fred Anderson, Director of the Center for Outcomes Research at the
University of Massachusetts Medical School who conducted the study commented
"ENDORSE shows that a substantial proportion of hospitalized patients are at
risk for VTE in each of 32 participating countries. Despite these objective
data that VTE risk is important on a global scale, the use of recommended
prophylaxis is sub-optimal. This is a complex problem, which will require
multiple solutions, including local and national programs of education,
guideline development, increased reimbursement for prophylaxis, and addition
of VTE prevention to the health-care agenda in every country."
VTE is a major public health issue and easily preventable disease among
patients hospitalized for acute medical and surgical illnesses. Deep vein
thrombosis (DVT) and pulmonary embolism are common manifestations of VTE and
can contribute significantly to morbidity and mortality.
Commenting on the study, Doctor Ander Cohen, Co-chair of the ENDORSE
Steering Committee, said "ENDORSE findings are important from national health
care perspectives since they allow estimation of both the patient welfare and
economic benefits of fully applying evidence based VTE prophylaxis among
hospitalised medical and surgical patients. If we want to improve hospital
patient outcomes, we urgently need to implement hospital-wide strategies to
identify all surgical and medical patients at risk for VTE and improve the use
of appropriate prophylaxis to prevent VTE."
Despite International and local guidelines on VTE management, ENDORSE
results illustrate clearly that there is a gap between guidelines evidence and
practice in the hospital setting throughout the world. Lack of awareness and
uncertainty about the prevalence of patients at risk of VTE are among the
major reasons accounting for this gap(2),(3).
As highlighted by Doctor Victor Tapson, Co-chair of the ENDORSE Steering
Committee: "ENDORSE clearly shows that VTE is a critical safety issue in
hospitalized patients, as the majority of them are at risk for VTE. The
increased use of prophylaxis in the surgical setting for which the benefits of
prophylaxis have been accepted for many years compared with medical setting
for which trials and guidelines are more recent, shows that we have to
increase physician awareness on the benefits of prophylaxis particularly in
About venous thromboembolism (VTE)
Venous thromboembolism is a general term used to describe the formation
of a blood clot (thrombus) that blocks a vein. This may occur in any part of
the venous system, but the most common manifestations are deep-vein thrombosis
(DVT), usually in the leg, and pulmonary embolism (PE).
VTE is a common complication among patients hospitalized for major
surgery or with a severe medical illness.
To date, ENDORSE is the largest international study performed in
hospitals selected at random around the world to evaluate VTE risk and
prophylaxis practice globally. Patients were enrolled at 358 randomly selected
hospitals in 32 countries in Europe, North America, South America, Middle
East, Asia, Australia, and North Africa.
The primary objectives of ENDORSE were to identify patients at risk for
VTE among patients hospitalized in representative hospitals throughout the
world and determine the proportion of at-risk hospitalized patients who
receive effective VTE prophylaxis by using the definition of patients at risk
of VTE and prophylaxis recommendations provided by the American College of
Chest Physicians (ACCP) evidence-based consensus guidelines(2). The secondary
objectives of ENDORSE were to define the global rate of medical and surgical
patients at risk for VTE, define the overall rate of patients receiving
appropriate prophylaxis in medical vs surgical populations and carry out
analysis by country and region.
The study included two categories of hospitalized patients: patients in
medical wards 40 years of age or older, and patients in surgical wards,
18 years or older. All hospital wards with acute medical or surgical patients
were eligible for the survey.
About COR (Center for Outcomes Research)
The Center for Outcomes Research (COR) serves as the scientific
coordinating center for a growing number of national and international
outcomes registries. COR's responsibilities include maintaining patient and
physician confidentiality, design of data collection instruments, data
management and publication development.
Established in 1994, COR is an outgrowth of the Worcester Deep Vein
Thrombosis Study, a five-year NIH-supported program, which demonstrated that
physicians are more likely to improve patient management practices if they are
provided with valid data on their own practices and outcomes along with
regional and national benchmarks.
About the University of Massachusetts Medical School
The University of Massachusetts Medical School, one of the fastest
growing academic health centers in the country, has built a reputation as a
world-class research institution, consistently producing noteworthy advances
in clinical and basic research. The Medical School attracts more than
$174 million in research funding annually, 80 percent of which comes from
federal funding sources. For more information, visit http://www.umassmed.edu.
ENDORSE study funding
The Center for Outcomes Research (COR) at the University of Massachusetts
Medical School received an unrestricted grant from sanofi-aventis to support
(1) Cohen AT, Tapson VF and all. The Lancet Vol 371, 2008
(2) Goldhaber SZ, Tapson VF. Am J Cardiol. 2004;93:259-62.
(3) Anderson FA, Jr., Zayaruzny M, Heit JA, Fidan D, Cohen AT. Estimated
annual numbers of US acute-care hospital patients at risk for venous
thromboembolism. Am J Hematol. 2007. Sep;82(9):777-82.
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