Deep vein thrombosis (DVT) continues to be a serious condition with a high mortality and morbidity rate (1). Hospitalized patients who are critically ill and have limited movement are at an increased risk of venous thromboembolism (VTE), which can lead to deep vein thrombosis (DVT) and pulmonary embolism (PE) (2). Between 50,000 and 200,000 of the 600,000 hospital admissions associated with DVT result in a pulmonary embolism (3). An estimated 10 million cases of hospital-related venous thromboembolism occur annually, making it a major source of illness and mortality worldwide (4). The occurrence of these complications can be reduced by healthcare personnel implementing effective prevention strategies, such as early mobilization and pharmaceutical prophylaxis. Furthermore, educating patients about symptom recognition and mobility maintenance can improve outcomes and reduce the impact of VTE (5).

In the absence of prevention, a significant number of medical patients experience an increased DVT rate (6). The occurrence of VTE often complicates the treatment plan for hospitalized patients (7). The risk of DVT and its associated consequences in hospitalized patients is considerably decreased when appropriate thromboprophylaxis, such as anticoagulant drugs or mechanical devices, is used (8, 9). However, in hospital settings, thromboprophylaxis is often either underappreciated or overused (10, 11). Negative effects, such as increased morbidity, mortality, and medical expenses, can result from the improper use of DVT prophylaxis—whether through underutilization or overutilization (12).

Inappropriate or non-existent DVT prevention in hospitalized patients can have fatal consequences. Patients with DVT are at a high risk of developing serious complications, including pulmonary embolism, which can lead to significant long-term health issues or even death (13). Furthermore, the development of DVT can lead to long-term complications, such as bleeding, recurrent venous thrombosis, chronic post-thrombotic syndrome (PTS) sequelae, persistent dyspnea following PE, and chronic thromboembolic pulmonary hypertension (14).

In the context of Ethiopia, only a small number of studies have evaluated whether DVT prophylaxis should be used among hospitalized patients in Ethiopia. Research from Jimma University Specialized Hospital revealed that only 37.3% of eligible patients received appropriate thromboprophylaxis (15). Another study conducted at Tikur Anbessa Specialized Hospital at Addis Ababa University revealed that 54.7% of patients received the recommended DVT prophylaxis (16).

The aim of this study was to assess the appropriateness of DVT prophylaxis use among patients admitted to the medical ward of Debre Tabor Comprehensive Specialized Hospital in Northwest Ethiopia. Understanding the fundamental causes of inadequate DVT prophylaxis is essential for formulating interventions that enhance patient outcomes. A detailed assessment of current practices and the identification of opportunities for improvement can help shape the development of targeted interventions to enhance patient safety and quality of care.

Prophylactic treatment of deep vein thrombosis can save lives and prevent non-fatal symptomatic thromboembolism. It can also help avoid post-thrombotic syndrome, which is estimated to affect 15–40% of those who have had DVT in the past (23). These outcomes are highly beneficial in terms of human resources. Therefore, patients in our hospitals should receive careful evaluation regarding the prophylaxis of deep vein thrombosis. Many patients who are at significant risk of complications do not receive thromboprophylaxis, despite its potential benefits. If thromboprophylaxis is not contraindicated, patients with a total risk score higher than 4 should be studied. In our findings, the most common absolute contraindications that excluded the patients from receiving thromboprophylaxis included being older than 65 years, ICU admission, and a GFR of less than 30 mL/min/a. Nonetheless, a study conducted by the American University of Beirut Medical Center found that the most common contraindication was renal impairment (24).

The current study found that 17.81% of eligible patients did not receive thromboprophylaxis, which is consistent with an Iranian study reporting 18.3% (7). However, compared to a study conducted in Australia, only 23% of patients in the medium-risk group and 5% in the high-risk group received the recommended preventive treatment (23). The inability to accurately classify patients into the appropriate risk group and the difficulty in selecting appropriate prophylaxis for a specific risk group are key factors contributing to inappropriate thromboprophylaxis. Another reason thromboprophylaxis is not administered is that patients with a high risk of DVT may have multiple diagnoses, with the primary and major diagnoses taking priority over the risk of DVT in each individual patient. Clinicians’ lack of awareness of DVT prophylactic protocols and DVT risk stratification may also contribute to the underuse of thromboprophylaxis (23, 25).

According to the results of the current investigation, thromboprophylaxis regimens were administered improperly to approximately 21.37% of patients after 365 patients were assessed using the Padua assessment tool. Similar low rates were also noted in research conducted in other Asian countries (26, 27) and Iran (7). However, the rate in our study was lower than those of previous studies conducted in California (28), Brazilian Society (29), and sub-Saharan Africa (30). Some studies have also indicated that venous thromboembolism remains the primary cause of unexpected mortality, despite patients having received appropriate prophylaxis (19). This discrepancy might result from the fact that our study exclusively focused on pharmacologic prophylaxis, while the prior study evaluated the use of both pharmaceutical and mechanical prophylaxis. Furthermore, although our study used the Padua assessment tool, other studies also used alternative assessment techniques.

Our investigation revealed that the place of the patient’s admission, the duration of their hospital stay, and the types of physicians they saw were the main contributors to the improper use of thromboprophylaxis. As a result, individuals who spent 7 days or more in the hospital had a 6-fold increased risk of inappropriate thromboprophylaxis use compared to those who stayed for fewer days. These findings are in line with those of previous studies (31, 32). As a result, sitting still may make it difficult to move the legs and may even cause compression, reducing blood flow to the legs. Remarkably, the group classified as having sedentary professions had a higher risk of DVT, which medical professionals may overlook or fail to notice if patients remain in the hospital for an extended period. Due to bed shortages, extended stays in acute hospitals hinder patient flow and access to care while also increasing the risk of hospital-acquired illnesses. The shortage of hospital beds raises concerns about patient safety and the adequacy of the healthcare system’s infrastructure (33).

The hospital’s place of admission was another factor contributing to the incidence of improper thromboprophylaxis usage. Consequently, patients admitted to the ICU had approximately a 4-fold higher risk of inappropriate DVT prophylaxis use compared to those admitted to non-ICUs. Inappropriate use of DVT prophylaxis in the ICU has also been reported in previous studies (34–36). Since DVT is often clinically silent in the ICU, especially in patients who are sedated and on mechanical ventilation, the majority of patients admitted there do not receive the recommended thromboprophylaxis. As ICU-acquired thromboembolic events may resemble a variety of other illnesses, they are challenging to detect (37).

In our study, the individuals treated by specialists received appropriate DVT prophylaxis at a rate approximately double that of those treated by general practitioners. This result is consistent with research showing that specialists, compared to general practitioners, typically exhibit better adherence to guidelines, ensuring the proper use of prophylactics (38). One possible explanation for GPs’ improper use of thromboprophylaxis is a lack of awareness and familiarity with evidence-based practices. A problem frequently noted in the sub-Saharan African context is the severe shortage of experts in healthcare systems in low-resource environments, such as Ethiopia, which forces general practitioners to handle complex situations without the necessary resources or experience (39). General practitioners may be encouraged to use prophylaxis in low- to high-risk patients, for whom the risks may outweigh the benefits, using performance indicators that promote DVT prophylaxis for all medical patients. However, specialists are better able to identify people who will actually benefit from it (40). Since similar approaches have significantly enhanced DVT prophylaxis in low-resource healthcare systems, it is recommended that GPs participate in ongoing professional development programs and systematically incorporate thromboprophylaxis guidelines into their daily practices to close these gaps (41).

Our investigation revealed that the supply of interventions resolved 95% of the problems associated with inappropriate deep vein thromboprophylaxis use, a finding supported by previous studies (7, 42), which demonstrated that clinical pharmacy interventions are statistically significant in preventing the improper use of DVT prophylaxis. Another study conducted in Belgium (43) reported that pharmacist-driven interventions increased the percentage of critically ill medical patients receiving VTE prophylaxis, with benefits that persisted over time. Compared to education-based approaches, there was a notable improvement during the pharmacist-intervention phase. It is more effective to use clinical pharmacy interventions, particularly when it comes to maintaining optimum thromboprophylaxis (44, 45). Clinical pharmacists can help healthcare professionals apply antithrombotic prophylaxis and medication use rationally in hospitals by using various risk assessment tools and providing support.

In our study, the appropriateness of DVT prophylaxis use was suboptimal, especially among the patients treated by general practitioners, those hospitalized in the intensive care unit, and those confined to the ward for longer than a few days. Using an integrated risk stratification checklist is an effective way to globally increase the use of DVT prophylaxis. Staff members working in medical wards should follow protocols and possess an understanding of thromboprophylaxis and DVT risk factors.