Hospitalized Sufferers on Thromboembolism and Thromboprophyla

Hospitalized Patients on Thromboembolism and Thromboprophyla

Hospitalized Sufferers on Thromboembolism and Thromboprophyla


Venous thromboembolism (VTE) encompasses pulmonary embolism (PE) and deep vein thrombosis (DVT). Lengthy-term hospitalization is ceaselessly sophisticated by VTE, inflicting extended hospital keep. Globally, VTE can be the main explanation for preventable hospital dying.1–4Proof-based methods had been carried out to find out the sufferers at excessive danger for VTE, equivalent to aged individuals and people with congestive coronary heart failure, most cancers, or sufferers who endure main surgical procedure.5 Sometimes, sufferers who’re acknowledged to be at excessive danger of VTE ought to be supplied with pharmacological prophylaxis on admission. Low dose anticoagulants, equivalent to unfractionated heparin (5000 IU each 8–12 hours) or low-molecular weight heparin (40 mg on daily basis or 30 mg twice a day), are essentially the most generally used anticoagulants prophylaxis for hospitalized medical and common surgical sufferers and ought to be continued all through the interval of VTE danger elements.6 Non-vitamin Ok antagonist oral anticoagulants (NOACs) have gotten extra interesting for long-term VTE prophylaxis. Proof exhibits that NOACs exert extra scientific advantages with out enhance in hemorrhage in Complete Hip and Knee Arthroplasty in contrast with conventional non-NOACs.7 Mechanical prophylaxis (eg, antiembolism stockings or intermittent pneumatic compression) might be offered to the hospitalized sufferers in whom pharmacological prophylaxis is contraindicated, and so they as properly ought to be prolonged till the affected person is sufficiently in a position to stroll.8

Proof helps that each one hospitalized sufferers ought to be counselled in regards to the danger elements and penalties of VTE, the antagonistic results of thromboprophylaxis medicines, and the suitable risk-reduction modalities previous to initiating thromboprophylaxis.9 Research have proven that restricted affected person information might negatively impression affected person involvement in VTE remedy and prophylaxis.10–14 Educating the affected person earlier than remedy initiation might improve adherence, particularly when the sufferers recognize their remedy objective and the results of refusing thromboprophylaxis. A living proof, a examine by Piazza et al discovered {that a} pharmacist-led individualized affected person training program was related to greater remedy compliance and discount in affected person refusal. Thus, VTE has been acknowledged as a public well being downside, and the precedence of elevating public information of this situation is critical to scale back mortality and morbidity.15

No research have evaluated public consciousness of thromboembolism and thromboprophylaxis in Yemen. This means a significant necessity to conduct this analysis to acquire details about the extent of VTE information amongst sufferers. This info will assist the medical employees think about the worth of instructional packages for VTE sufferers to extend sufferers’ consciousness. Subsequently, this examine aimed to evaluate the extent of public consciousness about VTE and its prophylaxis amongst hospitalized sufferers in private and non-private hospitals in Sana’a, Yemen. Additional, this examine can even decide the attention stage of thromboembolism and thromboprophylaxis predictors.

Supplies and Strategies

Research Design and Location

This can be a cross-sectional examine the place a validated questionnaire was distributed amongst hospitalized sufferers in two public hospitals (Kuwait Instructing Hospital, Aljomhori Instructing hospital) and 5 personal hospitals (College of Science and Know-how Hospital, Al-Khazan Hospital, Yemeni German Hospital, Saudi German Hospital and C-Plas Hospital) in Sanaa, the capital of Yemen. The above-mentioned hospitals had been chosen since they’re the most important educating hospitals and canopy the general public and the personal well being sectors. The examine was carried out from June to November 2020.

Ethics Approval and Consent to Take part

The protocol of this examine was authorised by the Moral Committee of the Medical Analysis on the College of Science and Know-how (Ref no: EAC/UST180). All individuals had been knowledgeable in regards to the examine goals and consented to take part. This examine complies with the Declaration of Helsinki, and all its amendments and revisions.

Research Inhabitants, Pattern Dimension and Sampling Technique

The variety of hospital beds in each private and non-private sectors in Sana’a metropolis was 2765 beds.16 Assuming a confidence stage of 95%, a margin of error of 5%, and a response distribution of fifty%, the minimal consultant pattern dimension was 338 primarily based on Raosoft software program (Raosoft. Inc., Seattle, USA). The pattern dimension was elevated by 22%, ie, n = 413, to account for the non-response fee. Sufferers had been chosen by handy sampling.

Inclusion and Exclusion Standards

Individuals who had been hospitalized within the inner drugs wards and obtained DVT prophylactic dose of low molecular weight heparin (enoxaparin 30 mg twice each day or 40 mg as soon as each day) or unfractionated heparin (5000 models two to a few instances a day) had been recruited within the examine. Those that had been admitted to the crucial care unit, emergency and those that had been on the primary day of their admission had been excluded from the examine.

Research Instrument

Beforehand validated questionnaires had been used with slight modifications on their objects.10,14 A ahead translation from English to Arabic was carried out. To make sure the validity of the content material, the examine instrument was reviewed by a multidisciplinary panel of consultants: two cardiologists, one neighborhood drugs doctor, and two holding a grasp’s in Medical Pharmacy. The instrument of the examine was piloted on a pattern (n = 24) of hospitalized sufferers who had been excluded from the ultimate evaluation of the examine. As well as, the reliability of the survey was examined utilizing Cronbach’s alpha, the place the general Cronbach’s alpha worth was 0.766. The questionnaire concerned twenty-nine closed-ended questions ready to find out: sufferers’ sociodemographic knowledge, together with age, gender, instructional stage (low stage is secondary college and fewer), smoking standing, the explanation for admission, comorbidities, and private/household historical past of VTE or utilizing thromboprophylaxis. Along with extra questions had been integrated to evaluate sufferers’ information in regards to the definition, scientific shows, danger elements, underlying causes, potential issues, and prevention measures of VTE. These questions had been integrated as multiple-choice questions, and an choice “I don’t know/undecided” was inserted as a final selection for every query in order that the p.c demonstrating the information was not overestimated by way of guessing the proper reply. The remainder of the questions assessed sufferers’ notion in direction of VTE and thromboprophylaxis, their satisfaction with thromboprophylaxis, and the data they obtained from health-care suppliers. Notion and satisfaction objects had been assessed utilizing the nominal scale with “sure” or “no” questions. The sufferers who answered “sure” to those questions had been categorised as glad and those that answered “no” had been categorised as unhappy.

Statistical Evaluation

Categorical variables, ie, the demographic traits, comorbidity, the explanation for admission, private and household historical past of DVT and PE, individuals’ consciousness of the proper danger elements, indicators and signs, issues, preventive measures of DVT and PE, individuals’ constructive notion of VTE and satisfaction about thromboprophylaxis (indicated by a response of sure or no) had been represented as frequency and proportion. Individuals had been categorised as “conscious” of VTE once they accurately answered 4 or extra questions associated to consciousness of VTE together with definition, causes, signal and signs, issues, danger elements, and preventive methods of VTE. Those that answered lower than 4 questions had been categorised as “unaware” of VTE. Univariable logistic regression was utilized to analyze the affiliation between individuals’ variables and the attention of VTE. Variables with p worth of lower than 0.25 in univariable logistic regression had been included within the multivariable logistic regression to create a mannequin of variables that finest predict individuals’ consciousness towards PE and DVT. To measure the impact of every predictor on the attention stage, odd ratios had been calculated. All statistical analyses had been carried out utilizing SPSS (Launch 21.0; IBM Corp., Armonk, NY, USA). Statistical significance was set at p < 0.05.


Of the 413 sufferers who obtained thromboprophylaxis, 396 agreed to finish the examine questionnaire, comprising a response fee of 94%. Desk 1 demonstrates the sociodemographic knowledge of the examine individuals. Most individuals had been between 18- and 40-year-old (41%, n = 164), females (73%, n = 289), had no career (74%, n = 293), had a low training stage (49%, n = 194), non-smokers (70%, n = 277), and had not less than one continual illness (32%, n = 125). The principle causes for hospital admission had been surgical procedure (57%, n = 226) or medical remedy (33%, n = 129). Majority of the individuals denied private historical past (92%, n = 351) and/or household historical past (86%, n = 282) of VTE.

Desk 1 Attribute of Individuals. Knowledge are Introduced as Frequency and Share

As proven in Desk 2, solely 31% (n = 121) of the individuals knew what a blood clot is. Among the many individuals who had been interviewed, solely 27 (7%) of the hospitalized sufferers acknowledged that DVT is a thrombus within the leg veins. Unilateral leg ache/tenderness (11%, n = 45), swelling (11%, n = 42), modifications within the leg’s colour (5%, n = 20), and warming of the leg (2%, n = 6) had been correctly acknowledged as indicators/signs of DVT. Nevertheless, 9% (n = 34) of the individuals partially acknowledged the indicators and signs of PE. Concerning VTE issues, proportions of 26% (n = 106) and 13% (n = 49) of the individuals acknowledged the proper issues of DVT and PE, respectively.

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Desk 2 Individuals’ Consciousness of Venous Thromboembolism. Knowledge are Introduced as Frequency and Share

Concerning the chance elements of creating VTE, 27% (n = 108) of the individuals acknowledged not shifting for a very long time as a danger of VTE, adopted by surgical procedure, hospital admission, most cancers, and being pregnant, comprising 11% (n = 45), 8% (n = 32), 6% (n = 23), and 4% (n = 17), respectively. Alternatively, strolling was accurately acknowledged by almost one-third (32%, n = 127) of the individuals as a VTE prevention technique.

Notion of Individuals About VTE

A lot of the individuals, 89% (n = 351) believed {that a} blood clot is a medical emergency that wants additional consideration and {that a} clot is perhaps prevented (66%, n = 261). Sixty p.c (n = 239) of the individuals believed that blood clots may trigger dying, and greater than half (55%, n = 218) of them had been conscious that, if not handled appropriately, a blood clot can go into the lungs (Desk 3).

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Desk 3 Individuals’ Notion of VTE and Their Satisfaction About Thromboprophylaxis. Knowledge are Introduced as Frequency and Share

Concerning thromboprophylaxis notion, most individuals (67%, n = 266) believed within the security and efficacy of thromboprophylaxis. Greater than two-thirds (70%, n = 276) of individuals by no means minded receiving injectable thromboprophylaxis, and nearly one-third (31%, n = 124) of them reported that the prophylactic heparin had tolerable antagonistic results (Desk 3).

Concerning individuals’ satisfaction with thromboprophylaxis, majority the individuals (69%, n = 274) had been glad with the dose scheduling of heparin or enoxaparin, which didn’t intrude with their each day actions or sleep sample. Nevertheless, solely 35% (n = 137) and 33% (n = 129) of the individuals, respectively, had been glad with the reason and the data they obtained about VTE thromboprophylaxis.

Outcomes of the Affiliation Between Demographic Elements and the Consciousness of VTE Utilizing Univariable Logistic Regression

The elements that may have an effect on individuals’ consciousness about VTE had been subjected to a univariable logistic regression. The proportion of individuals who reported unawareness of VTE was considerably greater among the many individuals who weren’t receiving sufficient details about VTE (OR = 7.254, P< 0.001), had been unhappy with info offered about VTE (OR = 6.877, P< 0.001), had no private historical past of VTE (OR = 5.717, P<0.001), disagreed with the time of receiving the injection (OR = 5.106, P<0.001), had no career (OR = 4.884, P < 0.001), weren’t being counselled in regards to the rationale of using VTE prophylaxis (OR = 4.797, P < 0.001), and those that had been illiterate (OR = 3.871, P < 0.001; Desk 4).

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Desk 4 Variables Related to Unawareness of DVT/PE Utilizing Univariable Binary Logistic Regression

Outcomes of the Affiliation Between Totally different Variables and VTE Consciousness Utilizing Multivariable Logistic Regression

9 variables had been included within the mannequin of multivariable logistic regression as proven in Desk 5. Individuals who didn’t have a career had OR = 17.182 (P < 0.001) of being unaware of DVT/PE in contrast with respondents who had a sure career. Those that had been illiterate had OR = 2.832 (P < 0.022) of being unaware of DVT/PE in contrast with those that had a better stage of training. Respondents who had no private historical past of DVT/PE had a OR = 7.580 of being unaware about VTE in contrast with those that had a private historical past of DVT/PE. Lastly, male individuals had OR = 2.839 (P < 0.005) of being unaware of DVT/PE in contrast with feminine.

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Desk 5 Variables Related to Unawareness of DVT/PE Utilizing Multivariable Binary Logistic Regression


The present examine’s findings indicated a lack of understanding about VTE among the many majority of the hospitalized sufferers in each the general public and the personal hospitals in Sana’a, Yemen. Almost one-third of hospitalized Yemeni sufferers answered questions associated to the character of blood clots accurately. However, most sufferers couldn’t acknowledge the indicators and signs of DVT and PE. This might need had a consequence on self-assessment and self-reporting of attainable VTE episodes. The findings of this examine agree with the discovering of research performed in different international locations within the Center East. For instance, a examine from Saudi Arabia by Almodaimegh et al discovered that solely 32% and 15% of sufferers had consciousness about DVT and PE, respectively.14 Equally, consciousness about DVT and PE amongst hospitalized Jordanian sufferers had been 38% and 22%, respectively.11 One other examine from Jordan performed by Alzoubi et al, which assessed consciousness of feminine sufferers who undergone cesarean part confirmed that there was poor information about VTE amongst individuals, notably younger females, with consciousness of 46% and 18.7% about DVT and PE, respectively.17 One other examine that was performed in Saudi Arabia by Almegren et al confirmed low information and consciousness of VTE among the many Saudi females who used or had been utilizing oral contraceptive tablets.18 Within the present examine, the individuals confirmed a better consciousness stage about DVT in comparison with PE. This consequence might be attributed to the truth that Yemeni sufferers had been unaware that PE is taken into account a complication of DVT. This discovering agrees with the examine performed in Jordan by Jarab et al.10 Alternatively in developed international locations, a examine from Canada by Saga et al discovered that almost all hospitalized sufferers (81.2%) had good information of each DVT and PE.13 One other examine from the USA by Konieczyńska et al reported that youthful sufferers had good information about VTE basically.19 Within the present examine, lack of understanding amongst individuals might be attributed partially to the truth that hospitalized sufferers in Yemen weren’t educated sufficient about their medicines and sickness nor actively engaged within the administration of their illnesses.

This examine revealed that respondents had poor information in regards to the danger elements of VTE and the required methods to forestall VTE in hospitalized sufferers. Thus, these sufferers won’t actively take part in DVT self-management. Epidemiological knowledge estimate that unhealthy life-style danger elements, together with weight problems, western dietary sample, bodily inactivity, might contribute to 48% of the unprovoked VTE. Thus, bettering high-risk people and common populations’ consciousness about VTE danger elements was proven to scale back the incidence of unprovoked VTE in the entire inhabitants by 12%.20 Within the present examine, essentially the most ceaselessly reported danger issue for VTE is extended restricted mobility. This discovering make clear the important function of health-care suppliers in educating their sufferers about the advantages of ambulating throughout hospitalization. This discovering is in settlement with different research that had been performed in Jordan,10 Saudi Arabia,14,21 and Canada.13 One other examine that was performed to measure world public consciousness of 9 international locations, together with the USA, the UK, the Netherlands, Thailand, Japan, Germany, Canada, Australia, and Argentina, confirmed that immobility is essentially the most acknowledged VTE danger consider these international locations.22 The examine individuals poorly acknowledged different danger elements of VTE, equivalent to being pregnant, malignancy, surgical procedure, and household historical past. Because of this, extra well being training about VTE in hospitalized sufferers is essential to make them lively individuals in VTE prophylaxis, thus, shifting VTE danger elements downward. Within the line with the next research,10,13 the discovering of this examine confirmed that strolling or stretching the legs is the nonpharmacologic technique to forestall VTE. Typically, inadequate information about VTE is a standard worldwide concern, notably for creating international locations equivalent to Yemen. A possible motive is the low training and never partaking the hospitalized sufferers in VTE self-management.

Enhancing consciousness of hospitalized sufferers to DVT/PE is crucial since such apply would have direct profit on the sufferers’ well being outcomes. For instance, when a hospitalized affected person is aware of that strolling within the hospital hall would have constructive impression on danger discount, he would begin strolling to scale back the chance as a substitute of staying in his mattress. Furthermore, for the reason that well being system and insurance coverage in Yemen is fragile because of the steady political battle, most sufferers in Yemen purchase their medicines from neighborhood pharmacies. This apply makes them underestimate the significance of thromboprophylaxis remedy and leaving them unaware of VTE and its penalties.

The suitable intervention to realize high-level consciousness about of VTE could also be achieved by establishing patient-physician counseling session earlier than initiating thromboprophylaxis. This apply may improve affected person’s function in VTE danger discount and enhance thromboprophylaxis adherence. Moreover, establishing VTE consciousness marketing campaign utilizing completely different platforms for these at elevated danger of VTE would have constructive impression on sufferers’ well being consequence. Furthermore, implementing scientific pharmacy companies in each the general public and the personal sectors are crucial since scientific pharmacists assessment sufferers’ medicines on each day foundation, present face-to-face counselling, and, thus, assist in decreasing drug-related issues.

Concerning the notion of individuals in direction of VTE, the vast majority of individuals (66%) agreed that VTE might be prevented and that untreated DVT may go into the lungs (55%). The attitudes of the individuals towards these two earlier factors had been just like that of the examine performed by Jarab et al10 however greater than that reported by Almodaimegh et al from Saudi Arabia. Moreover, 89% of the present examine individuals believed {that a} blood clot is a medical emergency that they should fear about it as it may well result in dying, which agrees with Almodaimegh et al examine.14 Similarity within the VTE notion of those earlier research is perhaps attributed partially to the similarity of the tradition among the many international locations the place these research had been performed.

On this examine, most respondents agreed that thromboprophylaxis is secure and efficient since such a drug wouldn’t be offered until it’s secure and efficient. Related findings had been reported from earlier research by Almodiamegh et al and Jarab et al.10,14 Solely a 3rd of the individuals reported their satisfaction with the clarification they obtained in regards to the rationale of VTE prophylaxis. One-third of the sufferers obtained info and counselling about DVT/PE. These findings may justify the low consciousness stage of the individuals about VTE, which in flip implies on the significance of offering the sufferers with the required counseling about VTE and its thromboprophylaxis. On this examine, the impact of demographic elements on the attention stage of the individuals was explored. Sufferers with a private historical past or household historical past of VTE had considerably greater consciousness ranges since they had been aware of the scientific shows of VTE. Moreover, sufferers who obtained details about VTE, or had been uncovered to explanations about thromboprophylaxis, had considerably greater consciousness than those that didn’t. Furthermore, individuals who had a sure career had been more likely to be educated, and thus that they had greater consciousness than those that had no career. These teams of sufferers are more likely to be taught extra in regards to the illness and its indicators and signs, which qualify them to undertake the chance discount technique of VTE.

Schooling additionally performs a big function within the consciousness stage.16 The present examine revealed that educated sufferers had considerably greater consciousness ranges than low training ranges or illiterate ones. The present examine’s findings are in step with earlier research.10,14 Affiliation between training stage of the individuals, receiving info and the attention of the illness was additionally confirmed by Oh et al. Their examine revealed that consciousness stage about stroke and its scientific shows was greater amongst educated respondents, and amongst those that obtained details about the stroke through completely different platforms, equivalent to web sites, public training, and campaigns.23 In a randomized trial, the attention stage about VTE was considerably improved from 8% to 87% amongst postpartum girls after implementing instructional packages about VTE that had been launched by their nurses.24 Alternatively, demographic traits equivalent to marital standing had no vital impact on the attention stage of the individuals. These outcomes are in step with Inexperienced and Bernhofer.25

The present examine outlines the lack of understanding about VTE in hospitalized sufferers, which signifies the significance of enrichment and bettering sufferers’ consciousness of VTE. In a affected person training program for VTE prevention in hospitalized sufferers by Piazza et al, it was discovered that pharmacist-led individualized affected person training classes had been related to greater remedy adherence to clinician-ordered injectable pharmacological venous thromboembolism prophylaxis.15

That is the primary examine to discover hospitalized sufferers’ perceptions and information of VTE prophylaxis in Yemen as a step ahead. This examine included seven personal and public hospitals in Sana’a, the capital of Yemen. Furthermore, the information for this examine was collected through face-to-face interviews that allowed researchers to pay attention and understand affected person’s need to be educated about such medical points. The present examine had a limitation, as some examine individuals had been illiterate, or their well being barred them from cooperating; subsequently, they had been requested reasonably than given the survey to reply. One other potential disadvantage is social desirability bias on consciousness and notion. Furthermore, this examine didn’t embrace questions associated to the hurt and issues of VTE prophylaxis, equivalent to bleeding and heparin induced thrombocytopenia. Yet another limitation was that the pharmacological prophylaxis of VTE was generally administered subcutaneously by health-care supplier. Subsequently, sufferers’ information and angle may not have nice impression on the practices. As properly, it’s value to say that odds ratios measure used within the present examine typically don’t present a superb approximation of the relative enhance in danger when the end result is frequent.


This examine exhibits a low consciousness stage towards VTE and its prophylaxis amongst hospitalized sufferers in Yemen. The examine reveals that these unaware of those illnesses have a flawed notion about DVT that impacts their roles in VTE administration. Future VTE administration packages ought to consider sufferers’ information to enhance their angle and apply towards managing their illness. The principles for thromboprophylaxis ought to be clarified to sufferers by well being care crew.


The authors wish to thank sixth yr PharmD college students Amal Alramadi, Hala althalji, and Shatha Alyousfi for serving to in knowledge assortment.


The authors report no conflicts of curiosity on this work.


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