IDENTIA Registry: Incidence of Deep Vein Thrombosis in Medically Ill Subjects at High Risk in Indonesia: A Prospective Study

Karmel L. Tambunan, Johan Kurnianda, Catharina Suharti, Shinta O. Wardhani, Lugyanti Sukrisman, Noorwati Soetandyo, Ni Made R.A. Rena, Nuzirwan Acang, Andi F. Benyamin, Muhammad Darwin Prenggono, Dairon Gatot, Trinugroho Heri Fadjari, Jacub Pandelaki


Background: medically ill hospitalized patients are at risk of deep vein thrombosis (DVT) and consequentially have high chances of mortality. In Indonesia, there is disparity in healthcare facility and data on incidence of DVT in this multi-ethnic, geographically unique country with large population are limited. Hence, we determined the incidence of DVT and evaluated mean Wells score among medically ill hospitalized persons at increased risk. Methods: in this multicenter, prospective, observational registry in Indonesia, subjects (age >40 years) with acute medical illness (like cancer, acute infection, or severe respiratory disease) confined to bed for >3 days were enrolled between January 2016 and November 2017. Data for medical history, Wells score, and DVT diagnosis with compression ultrasonography (CUS) were recorded. DVT incidence was analyzed in eligible and evaluable groups. Data were analyzed by descriptive method. Results: out of 360 subjects enrolled, 334 were included in the eligible group for analyses. CUS could not be performed in 26 subjects. Thus, 308 subjects who completed the study were included in the evaluable group. Javanese were predominant in the eligible group and obesity was the most common medical history at presentation. Overall, incidence of DVT in eligible and evaluable patients was 37.1% and 40.3%, respectively. Mean (SD) Wells score and bedridden days were 3 (1.20) and 9 (6.89), respectively. Conclusion: this study indicated that the incidence of DVT is high in medically ill patients in Indonesia and will provide new insights and awareness about DVT in Indonesia.


deep vein thrombosis; incidence; medically ill


Streiff MB, Lau BD. Thromboprophylaxis in nonsurgical patients. Hematology Am Soc Hematol Educ Program. 2012;2012:631-7.

Tapson VF. Acute pulmonary embolism. N Engl J Med. 2008;358:1037–52.

Turpie AG, Leizorovicz A. Prevention of venous thromboembolism in medically ill patients: a clinical update. Postgrad Med J. 2006;82:806-9.

White RH. The epidemiology of venous thromboembolism. Circulation. 2003;107:14-8.

Liew NC, Chang YH, Choi G, et al. Asian venous thromboembolism guidelines: prevention of venous thromboembolism. Int Angiol. 2012;31:501-16.

Lee LH, Gallus A, Jindal R, Wang C, Wu CC. Incidence of venous thromboembolism in Asian populations: a systematic review. Thromb Haemost. 2017;117(12):2243-60.

Hirsh J, Lee AY. How we diagnose and treat deep vein thrombosis. Blood. 2002;99(9):3102–10.

Wells PS, Hirsh J, Anderson DR, Lensing AW, Foster G, Kearon C, Weitz J, D’Ovidio R, Cogo A, Prandoni P. Accuracy of clinical assessment of deep-vein thrombosis. Lancet. 1995;345:1326–30.

Wells PS, Ginsberg JS, Anderson DR, et al. Use of a clinical model for safe management of patients with suspected pulmonary embolism. Ann Intern Med. 1998;129:997–1005.

Guyatt GH, Akl EA, Crowther M, Schünemann HJ, Gutterman DD, Lewis SZ. Introduction to the ninth edition: Antithrombotic therapy and prevention of thrombosis. 9th ed. American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141:48S–52S.

Barbar S, Noventa F, Rossetto V, Ferrari A, Brandolin B, Perlati M, De Bon E, Tormene D, Pagnan A, Prandoni P. A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: the Padua Prediction Score. J Thromb Haemost. 2010;8:2450–7.

Goldhaber SZ, Tapson VF; DVT FREE Steering Committee. A prospective registry of 5,451 patients with ultrasound-confirmed deep vein thrombosis. Am J Cardiol. 2004;93:259–62.

Tapson VF, Decousus H, Pini M, Chong BH, Froehlich JB, Monreal M, Spyropoulos AC, Merli GJ, Zotz RB, Bergmann JF, Pavanello R, Turpie AG, Nakamura M, Piovella F, Kakkar AK, Spencer FA, Fitzgerald G, Anderson FA Jr; IMPROVE Investigators. Venous thromboembolism prophylaxis in acutely ill hospitalized medical patients: findings from the International Medical Prevention Registry on Venous Thromboembolism. Chest. 2007;132:936–45.

Atmakusuma TD1, Tambunan KL, Sukrisman L, et al. Underutilization of anticoagulant for venous thromboembolism prophylaxis in three hospitals in Jakarta. Acta Med Indones. 2015;47:136-45.

Mahendradhata Y, Trisnantoro L, Listyadewi S, Soewondo P, Marthias T, Harimurti P, Prawira J (‎2017)‎. The Republic of Indonesia Health System Review, Health Systems in Transition. Vol-7 No.1. WHO Regional Office for South-East Asia.

Zwiebel WJ, Pellerito JS. Introduction to vascular ultrasonography. 5th ed. Philadelphia, PA: Elsevier Saunders; 2005. p. 456.

Goldhaber SZ. Risk factors for venous thromboembolism. J Am Coll Cardiol. 2010;56:1-7.

Karmacharya RM, Batajoo H, Shakya YR, Pradhan S. Applicability of Wells’ criteria for diagnosis of deep vein thrombosis in lower extremities at Dhulikhel Hospital, Kathmandu University Hospital. Ind J Vasc Endovas Surg. 2017;4:173–5.

Modi S, Deisler R, Gozel K, Reicks P, Irwin E, Brunsvold M, Banton K, Beilman GJ. Wells criteria for DVT is a reliable clinical tool to assess the risk of deep venous thrombosis in trauma patients. World J Emerg Surg. 2016;11:24.

Engbers MJ, Blom JW, Cushman M, Rosendaal FR, van Hylckama Vlieg A. The contribution of immobility risk factors to the incidence of venous thrombosis in an older population. J Thromb Haemost. 2014;12:290–6.

Farzamnia H, Rabiei K, Sadeghi M, Roghani F. The predictive factors of recurrent deep vein thrombosis. ARYA Atheroscler J. 2011;7:123–8.

Kyrle PA, Eichinger S. Deep vein thrombosis. Lancet. 2005;365(9465):1163–74.

Wells PS, Owen C, Doucette S, Fergusson D, Tran H. Does this patient have deep vein thrombosis? JAMA. 2006;295:199–207.

Baroncini LAV, França GJ, de Oliveira A, et al. Correlation of clinical features with the risk of lower limb deep vein thrombosis assessed by duplex ultrasound. J Vasc Bras. 2013;12:118–22.

Mahan CE, Fisher MD, Mills RM, Fields LE, Stephenson JJ, Fu AC, Spyropoulos AC. Thromboprophylaxis patterns, risk factors, and outcomes of care in the medically ill patient population. Thromb Res. 2013;132:520–6.

Chang SL, Huang YL, Lee MC, et al. Association of varicose veins with incident venous thromboembolism and peripheral artery disease. JAMA. 2018;319:807–17.

Barros MV, Arancibia AE, Costa AP, Bueno FB, Martins MA, Magalhães MC, Silva JL, Bastos Md. Incremental value of hormonal therapy for deep vein thrombosis prediction: an adjusted Wells score for women. Blood Coagul Fibrinolysis. 2016;27:328 33.

Stein PD, Beemath A, Olson RE. Obesity as a risk factor in venous thromboembolism. Am J Med. 2005;118(9):978–80.

Full Text: PDF


  • There are currently no refbacks.