Guidelines for the Management of Venous Thromboembolism In Nigeria

Abstract

Preamble The field of medicine has become so wide and the care  and  management  of  different  conditions  is transcending basic knowledge and requires guidelines for diagnosis, and prevention of several disease  entities.  Levels  of  medical  practice  differ from community to community and from one country to  another.  This  is  largely  due  to  the  fact  that advancement in medical knowledge particularly diagnostic  advancement  and  affordability  of  novel therapeutic interventions vary widely. The subject of thrombosis has not received sufficient attention in medical practice in Nigeria. There are very few Haematologists in Nigeria today with special interest or sub- specialization in haemostasis   (haemorrhagic and thrombotic disorders), thus few research efforts have been recorded in this subject area. Review of project dissertations to the National  Postgraduate  Medical  College  of  Nigeria  (NPMCN)  amongst fellow pathologists  show   that  very   few   theses   are  submitted   related to  the  subject     of haemostasis.     Whereas,   in   many   countries  including  some African      countries,  the epidemiology of  thrombosis and thrombotic disorders  (including the burden of  the diseases, the common acquired  predisposing  factors as well as inheritable    predisposing  factors)  have  been  well documented, no such data (particularly-   countrywide based) is available for Nigeria. The available literature from Nigeria is scanty and fragmented. We have no clear idea of the burden of thrombotic disorders in Nigeria, although we know from medical practice that several deaths post-surgery are related to thrombotic disorders.  A number of cases of sudden  deaths  are  diagnosed  at  post-mortem  as being due to complication of thrombotic disorders.  It is  estimated  from  few  hospital-based  studies  in Nigeria that inheritable predisposing factors to thrombosis may not be that rare.   Factor V Leiden has been documented   in at least 2%   of normal blood donors in Nigeria1, other studies  have shown that  Protein  C, Protein  S,    Plasminogen Activator Inhibitor levels deficiency may not be rare in 2,3 Nigeria . As part of its responsibility to Nigerians, the NSHBT is in a position to provide guidelines   for   prevention, diagnosis, care and treatment of diseases related to Haematology and Immunohaematological practice in Nigeria. With the support of few pharmaceutical companies in Nigeria, the Society has been able to produce Lymphoma Treatment Guidelines in Nigeria; this has undergone 1 a few updates in the recent past . At the Society's 42nd annual scientific and general meeting held in October 2016 in Lagos, the subject  of  thrombotic disorders  in Nigeria came to fore and the Society received guests from the International Society  on  Thrombosis  and  Haemostasis  (ISTH). During the conference, different aspects of thrombotic disorders were discussed, limitations in the  country  were  identified  with    respect    to diagnostic capacity, monitoring of anticoagulant therapy and affordability of newly available therapeutic intervention to Nigerians who suffer from thromboembolic disorders. At this conference ISTH charged and challenged Nigerian Haematologists to set up a Committee that should be saddled with the responsibility of: 1.    Promoting research on thrombosis and bleeding disorders 2.   Promoting  increased  level  of  exposure  and training  of  its  members  in  thrombotic  and bleeding disorders and 3.   Producing  treatment  guidelines  for  use  by practitioners  in  Nigeria  for  thromboembolic disorders. We thank the ISTH for its attendance at our meeting in the persons of Prof.   Andreas Greinacher from Germany, Prof. Suikish Nair from India, Dr.  Edoghogho  Olayemi  from  Ghana  and  Dr.    Claire Mclintock  from New  Zealand. We also appreciate some  senior  Haematologists  in  Nigeria  who  have shown interest in thrombosis and Haemostasis. In particular Prof. Etim   Essien a retired Professor of Haematology and blood transfusion, Prof.  Wuraola Shokunbi of University College Hospital Ibadan and the energetic Prof. Omolade Awodu of the University of  Benin  who  is  the  Chairman    of  this  guideline writing Committee and the eye of Nigeria at International  fora  in  thrombosis  and  haemostatic disorders. This  is  the  first  effort  in  developing  a guideline for the prevention, diagnosis, care, treatment and prophylaxis for thromboembolic disorders in Nigeria. This guidance is written according to the current best practices as published. However every patient should be evaluated as a person and therapy should be individualized THIS GUIDELINE IS REVIEWED BY EXPERTS  IN THROMBOSIS AND BLEEDING DISORDERS OF THE EDUCATION SUBCOMMITTEE OF THE INTERNATIONAL SOCIETY ON THROMBOSIS AND HAEMOSTASIS