Occurrence of Venous Thromboembolism and Outcomes of Preventive Protocols at the Bangkok Hospital Medical Center: a Retrospective Review of Years 2012-2013

Main Article Content

Chaisak Dumrikarnlert, MD
Chanpong Tangkanakul, MD
Sawang Saenghiranvattana, MD
Sombat Rojviroj, MD
Tanyaporn Tansakul, MD
Sarakorn Laongkaew, PharmD


To determine the occurrence of venous thromboem¬bolism (VTE) of patients at the Bangkok Hospital Medical Center (BMC). To collect data of VTE patients at the BMC about their characteristics, underlying diseases, presenting symptoms and out¬comes of diseases. Evaluate the outcome of preventive methods of VTE when using the BMC protocol.

The retrospective review was conducted from January 1, 2012 to December 31, 2013. The total number of patients diagnosed with VTE is 190 patients. The patients were divided into two groups; in the first group were patients who had been diagnosed in the year 2012, and were not using the preventive protocol, and the second group, were patients who had been diagnosed in the year 2013, and were using the preventive protocol. In both groups, data was collected about their characteristics, underlying diseases, presenting symptoms, and outcomes. Then we further divided patients from both groups into two categories by using BMC protocol criteria; high thrombosis risk and low thrombosis risk. Following this categorisation, we used the Statistical Package for the Social Sciences (SPSS) program to analyze the data collected. We compared populations across both years to verify if there was any difference in any aspect of the baseline characteristics. We evaluated the outcomes of patients who did not develop VTE as a result of using the preventive protocol by comparing high thrombosis risk patients to low thrombosis risk patients across both years to verify if there were any differences in the number of patients who did not receive the protocol (2012), and patients who received the protocol (2013).

There were 190 patients with VTE, 104 patients in 2012 (54.73%) and 86 patients in 2013 (45.27%). Their mean age was 63.52 ± 17.70 years. Ninety two patients (48.42%) are Thai nationals, while 98 patients (52.58%) are non-Thai nationals. There were 76 inpatient department (IPD) patients (40%) and 114 outpatient department (OPD) patients (60%). In IPD patients, there were 71 patients with a high thrombosis risk, 39 patients (37.50%) in 2012 and 32 patients (37.21%) in 2013. There are two statistically significant differences in the populations between both years, first the mean thrombosis risk score (which in 2013 had a higher thrombosis risk score ( 4.94 vs. 5.86)) and second, the number of patients that died from VTE (with more deaths occurring in year 2012 (10 vs. 1)). Patients who have a high thrombosis risk score in 2012 represent 37.50% of cases, and in 2013 these patients represented 37.21% of cases. The odd ratio (OR) is 1.013 (0.561 - 1.828), relative risk is 1.008 (0.696 - 1.459), relative risk reduction is 0.77 and numbers needed to treat (NNT) is 344.82.

From our study we showed a reduction of risk in a number of high thrombosis risk VTE patients when using the risk assessment protocol of BMC with the number need to treat of 344.82. Although it is not statistically significant, due to the limitations of the study, we have seen a trend towards using the protocol to decrease the number of high thrombosis risk VTE patients.


Download data is not yet available.

Article Details

How to Cite
Dumrikarnlert C, Tangkanakul C, Saenghiranvattana S, Rojviroj S, Tansakul T, Laongkaew S. Occurrence of Venous Thromboembolism and Outcomes of Preventive Protocols at the Bangkok Hospital Medical Center: a Retrospective Review of Years 2012-2013. BKK Med J [Internet]. 2014 Sep. 20 [cited 2023 Dec. 1];8(1):9. Available from: https://he02.tci-thaijo.org/index.php/bkkmedj/article/view/219719
Original Article


1. Chotanaphuti T, Foojareonyos T, Panjapong S, et al. Incidence of deep vein thrombosis in postoperative hip fracture patients in Phramongkutklao Hospital. J Med Assoc Thai 2005;88 S159-63.
2. Pookarnjanamorakot C, Sirisriro R, Eurvilaichit C, et al. The incidence of deep vein thrombosis and pulmonary embolism after total knee arthroplasty:the screening study by radionuclide venography. J Med Assoc Thai 2004;87:869-76.
3. Chotanaphuti T, Ongnamthip P, Silpipat S, et al. The prevalence of thrombophilia and venous thromboembolism in total knee arthroplasty. J Med Assoc Thai 2007;90:1342-7.
4. Chotanaphuthi T, Heebthamai D, Taweewuthisub W, et al . Prediction of deep vein thrombosis after total knee arthroplasty with preoperative D-dimer plasma measure-ment. J Med Assoc Thai 2009;92 Suppl 6:S6-10.
5. Niikura T, Lee SY, Oe K, et al. Venous thromboembolism in Japanese patients with fractures of the pelvis and/or lower extremities using physical prophylaxis alone. J Orthop Surg (Hong Kong) 2012;20:196-200.
6. Piovella F, Wang CJ, Lu H, et al. Deep-vein thrombosis rates after major orthopedic surgery in Asia. An epidemio-logical study based on postoperative screening with centrally adjudicated bilateral venography. J Thromb Haemost 2005;3:2664-70.
7. Leizorovicz A, Turpie AG, Cohen AT, et al. SMART Study Group. Epidemiology of venous thromboembolism in Asian patients undergoing major orthopedic surgery without thromboprophylaxis. The SMART study. J Thromb Haemost 2005;3:28-34.
8. Cohen A, Chiu KM, Park K, et al. Managing venous thromboembolism in Asia: winds of change in the era of new oral anticoagulants. Thromb Res 2012;130:291-301.
9. Pechevis M, Detournay B, Pribil C, et al. Economic evaluation of enoxaparin vs. placebo for the prevention of venous thromboembolism in acutely ill medical patients. Value Health 2000;3:389-96.
10. Nuijten MJ, Villar FA, Kosa J, et al. Cost-effectiveness of enoxaparin as thromboprophylaxis in acutely ill medical patients in Spain. Value Health 2003;6:126-36.
11. Duff J, Walker K, Omari A, et al. Prevention of venous thromboembolism in hospitalized patients: analysis of reduced cost and improved clinical outcomes. J Vasc Nurs 2013;319-14.
12. Gussoni G, Foglia E, Frasson S, et al. Real-world economic burden of venous thromboembolism and antithrombotic prophylaxis in medical inpatients. Thromb Res 2013;131:17-23.
13. National Institute for Health and Clinical Excellence. Reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to hospital. NICE clinical guideline. Accessed April 5, 2014, at https://www.nice.org.uk/CG092)
14. Tsai AW, Cushman M, Rosamond WD, et al. Cardiovas-cular risk factors and venous thromboembolism incidence: the longitudinal investigation of thromboem-bolism etiology. Arch Intern Med 2002;162:1182.
15. Folsom AR, Lutsey PL, Nambi V, et al. Troponin T, NT-proBNP, and venous thromboembolism: The Longitudinal Investigation of Thromboembolism Etiology (LITE). Vasc Med 2014;19:33.
16. Van Schouwenburg IM, Mahmoodi BK, Gansevoort RT, et al. Lipid levels do not influence the risk of venous thromboembolism. Results of a population-based cohort study. Thromb Haemost 2012;108:923.
17. Ageno W, Becattini C, Brighton T, et al. Cardiovascular risk factors and venous thromboembolism: a meta-analysis. Circulation 2008;117:93.
18. Rahr HB, Sorensen JV. Venous thromboembolism and cancer. Blood Coagul Fibrinolysis 1992;3:451-60.
19. Zangari M, Anaissie E, Barlogie B, et al. Increased risk of deep-vein thrombosis in patients with multiple myeloma receiving thalidomide and chemotherapy. Blood 2001; 98:1614-5.
20. Clahsen PC, van de Velde CJH, Julien JP, et al. Throm-boembolic complications after perioperative chemotherapy in women with early breast cancer: a European Organization for Research and Treatment of Cancer/Breast Cancer Cooperative Group Study. J Clin Oncol 1994;12:1266-71.
21. Warlow C, Ogston D, Douglas AS. Venous thrombosis following strokes. Lancet 1972;1:1305-6.
22. Shojania KG, Duncan BW, McDonald KM, et al. Making health care safer: a critical analysis of patient safety practices. Report/Technology Assessment No. 43. Rock-ville, MD: Agency for Healthcare Research and Quality. (Accessed April 5, 2014, at www.ahrq.gov/clinic/pt-safety/).
23. Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: CHEST Evidence-Based Clinical Practice Guide- lines.
24. Jobin S, Kalliainen L, Adebayo L, et al. Venous thrombo-embolism prophylaxis. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI) 2012:51.
25. Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008;133:381S-453S.
26. Lyman GH, Khorana AA, Kuderer NM, et al. Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol 2013;31:2189-204.
27. Farge D, Debourdeau P, Beckers M, et al. International clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer. J Thromb Haemost 2013;11:56-70.
28. Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Guidelines Committee. Guidelines for deep venous thrombosis prophylaxis during laparo-scopic surgery. Surg Endosc 2007;21:1007-9.