Global Risk Profile Verification in Patients with Venous Thromboembolism (GRIP VTE) in Five Gulf Countries.
Authors: Sayegh Faisal Al , Almahmeed Wael , Marashi Mahmoud , Bahr Ahmed , Mahdi Hasan Al , Bakir Sherif , Humood Salah Al , Al Farhan Maha 
Published: April 2020

Background: The Global Risk Profile Verification in Patients with Venous Thromboembolism (GRIP VTE) was the first prospective multicenter registry conducted in five 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 by multidisciplinary specialists from 28 contributing hospitals in the Gulf region (Kuwait, Bahrain, Qatar, Oman, and the UAE). Patients with a suspected diagnosis of VTE were included. The data management team at a sponsor-independent study coordinating center ensured data quality. Differences between groups were assessed by the Chi square test or Fisher exact test for categorical variables. The Student t-test was used for testing proportions. A two-tailed P value &lt;0.05 was considered significant. Doppler ultrasound and lung scans were the most preferred modalities in the diagnosis of deep vein thrombosis (DVT) and pulmonary embolism (PE).

Results: The table shows the incidence of VTE. The most common symptoms of DVT and DVT/PE patients were calf pain (72%), calf swelling (63.8%), and localized tenderness (52.2%). Calf pain and localized tenderness were significantly greater (P &lt;0.001) in cases of DVT alone than in cases of DVT/PE. The most common symptoms in patients with PE alone and DVT/PE were dyspnea (83.6%), thoracic pain (69.1%), and cough (40%). Cough and hemoptysis occurred more frequently in PE cases than in cases of DVT/PE (P &lt;0.001). Risk factors for VTE were immobilization &gt;3 days (41.3%), age &gt;65 years (28.9%), a history of VTE (20.7%), and trauma (19%). Surgical intervention in the previous year was an independent risk factor for VTE, 83.8% of such patients experiencing VTE within 4 weeks of surgery. There was a strong association between VTE and orthopedic procedures (P=0.0016). Among surgical interventions, orthopedic procedures induced the greatest number of VTE cases, followed by general surgical procedures and gynecological procedures. Low molecular weight heparins (LMWHs) were chosen to treat 33.7% of DVT cases, while unfractionated heparin (UFH) was used in 21.9% of cases. UFH use in PE and DVT/PE was 57.1% and 55%, respectively, and LMWHs use was 14.3% each for PE and DVT/PE. Oral anticoagulant use in DVT/PE, DVT, and PE was 30%, 19.8%, and 2.9%, respectively.

Conclusion: The main risk factors predisposing to VTE are immobilization, age &gt;65 years, a history of VTE, and trauma. The highest incidence was observed in medical patients, necessitating prophylaxis in patients at risk. Previous surgical interventions were independent risk factors for VTE, requiring extended prophylaxis, including outpatient thromboprophylaxis, in patients undergoing extensive surgical procedures.

Incidence of DVT, PE, and DVT/PE

DVT PE DVT/PE Frequency of cases - n (%) 187 (77.27%) 35 (14.46%) 20 (8.26%) Departments Medical 74 (39.5%) 19 (54.28%) 10 (50%) Surgical 61 (32.62%) 9 (25.71%) 6 (30%) Others 52 (27.8%) 7 (20%) 4 (20%)