The increasing use of central venous catheters in hospitalized patients has led to a rising incidence of upper extremity deep venous thrombosis (DVT). The use of venous thromboembolism (VTE) pharmacoprophylaxis in hospitalized patients has been shown to be effective in decreasing the incidence of pulmonary embolism and overall deep venous thrombosis but its effect on upper extremity DVT reduction has been less investigated.
Our academic medical center undertook a quality improvement initiative to increase VTE prophylaxis for all inpatients by implementing a universal prophylaxis approach where physicians had an option to opt out of pharmacologic prophylaxis only if patients met certain predefined contraindications. Phases of this initiative included the formation of order sets which standardized timing and dosage of prophylaxis agents, development of standardized contraindications across disciplines, adoption of clinical reminders when anticoagulation was dropped, formation of a nursing program that emphasized the importance of mechanical devices and its usage for a minimum of 1820 h daily, and the development of a unitbased prophylaxis report to provide real time feedback on prophylaxis rates. The incidence of upper extremity DVT was calculated per 1,000 discharges for medicine patients and was monitored before and after the implementation of this hospital wide prophylaxis strategy. The preimplementation study period was September 2008 to March 2010 and the post intervention period was April 2010 to August 2011.
Of the 41,725 medical patients discharged from our academic medical center during the study period, 5.2 per 1,000 were diagnosed with a symptomatic upper extremity DVT prior to the implementation of a universal prophylaxis approach and 2.9 per 1,000 were diagnosed in the post intervention period (Figures 1 and 2).
The use of universal prophylaxis for all medical patients had an impact in decreasing the incidence of upper extremity DVTs. Although not quantified in this study, the use of PICC lines and central venous catheters increased at our institution during the study period. Thus, in the highrisk population for upper extremity DVTs such as those with catheters, pharmacologic prophylaxis, unless contraindicated, should be used to decrease the incidence of upper extremity events.
To cite this abstract:Shah H, Dyke J, Greene S. Effectiveness of a Universal Venous Thromboembolism Prophylaxis Strategy in Decreasing Upper Extremity Deep Venous Thrombosis. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97580. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/effectiveness-of-a-universal-venous-thromboembolism-prophylaxis-strategy-in-decreasing-upper-extremity-deep-venous-thrombosis/. Accessed April 25, 2019.