Venous thromboembolism (VTE) is a common yet preventable complication affecting hospitalized patients. Appropriate VTE prevention has emerged as an important hospital quality measure with emphasis on enforcing routine risk assessment and compliance with VTE prevention guidelines. Several pharmacologic options are available for VTE prevention; however, adherence to thromboprophylactic therapies is largely unknown. In addition, adherence rates may vary between unfractionated heparin (UFH), which is administered multiple times daily, and lowmolecularweight heparins (such as enoxaparin), which are typically administered once daily. As a quality improvement initiative, we compared the adherence rates of UFH and enoxaparin amongst hospitalized internal medicine patients. To our knowledge, only one previous trial with a small sample size and a mixed medical and surgical patient population has addressed this issue.
From July 2009 to June 2010, we used administrative data including the electronic medication administration record (eMAR) at a large university hospital to analyze the physician orders and drug administration status of subcutaneous UFH three times daily (TID) and subcutaneous enoxaparin once daily (QD) for hospitalized internal medicine patients over the age of 18. Patients were excluded, if their hospital length of stay was less than 24 h, or if they were transferred off the internal medicine service (i.e., to a surgery service) at any time during their hospitalization. VTE prophylaxis adherence was defined as the percentage of doses administered compared to doses ordered. The Pearson Chisquared statistical analysis was used to determine, if there was a significant difference in adherence between the two prophylactic regimens.
6,703 patients met the inclusion criteria and had VTE prophylaxis orders for either UFH TID or enoxaparin QD. VTE prophylaxis adherence in the UFH group (n = 5,366) was 86.6% while adherence in the enoxaparin group (n = 1,337) was 91.1% (P < 0.001).
VTE prophylaxis with enoxaparin once daily had better adherence when compared to UFH three times daily. This difference was statistically significant, however whether it has clinical significance is unknown. We hypothesize that the most common reason for VTE prophylaxis omissions was patient refusal.
To cite this abstract:Hu H, Vellinga J, Grant P, Bahl V. Venous Thromboembolism Prophylaxis Adherence in Hospitalized Medical Patients. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97593. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/venous-thromboembolism-prophylaxis-adherence-in-hospitalized-medical-patients/. Accessed March 28, 2020.