Venous thromboembolism (VTE) is the third‐leading cause of cardiovascular death. Approximately 60,000 people die from VTE each year; however, VTE is the most common preventable cause of hospital death. Without prophylaxis, VTE occurs in 10%–26% of medicine patients. This study assessed rates of pharmacologic and mechanical venous thromboembolism prophylaxis at an academic medical center.
Using the hospital's Enterprise Data Warehouse, medicine patients admitted between July 1, 2007, and January 31, 2008, were reviewed for VTE prophylaxis usage. A total of 2463 patients were included. Patients who had low‐molecuiar‐weight heparin (LMWH), warfarin, or unfractionated heparin ordered within 24 hours of admission were counted as having received VTE pharmacologic prophylaxis. Patients who had sequential compression devices (SCDs) or TED hoses ordered within 24 hours of admission were counted as having received mechanical prophylaxis. Patients with laboratory values of PTT > 60, platelets < 100,000, or INR > 1.6 within 24 hours of admission were considered to have a laboratory contraindication to Dharmacoloaic DroDhvlaxis.
A breakdown of VTE prophylaxis use in this population is shown in Figure 1. Twelve percent of medicine patients in the study did not receive pharmacologic or mechanical prophylaxis (complete miss). Three percent of patients were identified as having a contraindication to chemoprophylaxis because of laboratory values; however, these patients did not receive mechanical prophylaxis. Of the 12% of patients who did not receive prophylaxis, a subset of these patients may have had contraindications to chemoprophylaxis (and should have received mechanical prophylaxis) or had no contraindications to chemoprophylaxis (which should have been administered). In addition, of the 20% of patients who received only mechanical prophylaxis, a subset of patients (moderate to high risk) may have been candidates for pharmacologic prophylaxis (resulting in underprophylaxis).
This study indicates that a substantial portion of medicine inpatients (12%) are not receiving any type of VTE prophylaxis. In addition, a portion of patients at moderate to high risk may be underprophylaxed for VTE because they received only mechanical prophylaxis (recommended only if there is a true contraindication to pharmacologic prophylaxis or to be used as an adjunct in those at highest risk). In addition, strategies to improve documentation of contraindications to VTE prophylaxis should be pursued. All medicine patients should receive VTE prophylaxis or have a contraindication clearly documented in the patient's chart.
H. Shah, none; J. Van Dyke, none; D. Malkenson, none; S. Greene, none; C. Watts, none.
To cite this abstract:Shah H, Dyke J, Malkenson D, Greene S, Watts C. Venous Thromboembolism Prophylaxis in Hospitalized Patients: An Academic Medical Center Experience. Abstract published at Hospital Medicine 2009, May 14-17, Chicago, Ill. Abstract 92. Journal of Hospital Medicine. 2009; 4 (suppl 1). https://www.shmabstracts.com/abstract/venous-thromboembolism-prophylaxis-in-hospitalized-patients-an-academic-medical-center-experience/. Accessed March 28, 2020.