Inpatient thromboprophylaxis use in U.S. hospitals: Adherence to the seventh American College of Chest Physician's recommendations for at‐risk medical and surgical patients

Amin, Alpesh; Stemkowski, Stephen; Lin, Jay; Yang, Ge

doi:10.1002/jhm.526

Cited by 62 publications

(35 citation statements)

References 17 publications

(21 reference statements)

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“…Despite the recommendation, there remain a significant proportion of individuals who underwent orthopedic surgery but who were not prescribed prophylactic measures. A study of 188 800 surgical discharge records during [2005][2006] found that approximately 20% of surgery patients did not receive VTE prophylaxis during hospitalization [25]. Another study found that only 19% of persons undergoing knee or hip replacement surgery received postdischarge anticoagulant therapy [26].…”

Section: Discussionmentioning

confidence: 99%

Incidence rates for thromboembolic, bleeding and hepatic outcomes in patients undergoing hip or knee replacement surgery

Lanes¹,

Fraeman²,

Meyers

et al. 2011

Journal of Thrombosis and Haemostasis

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Summary. Background: Data on clinical outcomes of patients in the general population undergoing knee replacement or hip replacement surgery are sparse. Objectives: To conduct an observational study using insurance claims data to assess the incidence of selected clinical events following knee replacement or hip replacement surgery in the USA. Patients/Methods: A total of 97 469 knee replacement patients and a total of 45 203 hip replacement patients were included during the period 2004–2008; the median age was 64 years, and 63% of knee replacement patients and 55% of hip replacement patients were women. Results: During a median follow‐up of 70–71 days, the incidence rates in knee replacement patients and hip replacement patients were, respectively: ischemic stroke, 15 and 19 per 1000 person‐years; acute coronary syndrome (ACS), 15 and 18 per 1000 person‐years; bleeding events, 46 and 47 per 1000 person‐years; venous thromboembolism (VTE), 64 and 45 per 1000 person‐years; and hepatic events, one and one per 1000 person‐years. Approximately 45% of knee replacement and hip replacement patients had no claims for outpatient anticoagulant therapy within 1 week after discharge from hospital. Conclusions: Ischemic events such as stroke, ACS and VTE are important adverse events following knee replacement and hip replacement surgery. The results reported here can help in making challenging decisions regarding the clinical management of risks attributable to bleeding events and clotting events.

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Section: Discussionmentioning

confidence: 99%

Incidence rates for thromboembolic, bleeding and hepatic outcomes in patients undergoing hip or knee replacement surgery

Lanes¹,

Fraeman²,

Meyers

et al. 2011

Journal of Thrombosis and Haemostasis

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“…In total, 75.1% of at-risk cancer patients did not receive any anticoagulation during their hospital stay. There appear to be differences in the use of prophylaxis in surgical compared with medical hospitalized cancer patients, with a trend toward higher rates of prophylaxis in surgical patients with cancer [25,44,57,59]. In a study by Amin et al [57] of 30,124 surgical and 42,213 medical cancer hospitalized patients, the overall rate of any pharmacologic or mechanical prophylaxis given was 69.6 and 42.2%, respectively.…”

Section: Gaps In the Provision Of Vte Prophylaxis In The Cancer Patiementioning

confidence: 94%

“…Despite the established increased risk of VTE in the cancer patient population and the availability of evidencebased guidelines recommending thromboprophylaxis, several studies have demonstrated that VTE prophylaxis is underutilized in at-risk cancer patients (Table 5) [38,41,44,[54][55][56][57][58][59][60][61][62][63]. In a recent retrospective study, inpatient, outpatient, and discharge databases were queried for anticoagulant use between January 2005 and December 2007 to assess VTE prophylaxis patterns across the continuum of care in 2,544 medical cancer patients at risk of VTE according to 2008 ACCP guidelines [60].…”

Section: Gaps In the Provision Of Vte Prophylaxis In The Cancer Patiementioning

confidence: 99%

Prevention of venous thromboembolism in cancer patients: current approaches and opportunities for improvement

Amin¹,

Deitelzweig

2011

Oncol Rev

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“…A number of studies [20][21][22][23][24] illustrate that hospitalized medical patients frequently do not receive ''appropriate'' prophylaxis (defined as appropriate dose, type, and duration). In addition, many patients do not meet VTE prophylaxis requirements endorsed by organizations in the US such as the Joint Commission [25,26].…”

Section: The Importance Of Prophylaxis In Medical Patientsmentioning

confidence: 99%

Standard or extended-duration prophylaxis in medical patients? A review of the evidence

Stark

Smith

2011

J Thromb Thrombolysis

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Acutely ill medical patients are at significant risk of venous thromboembolism (VTE). Thromboprophylaxis can substantially reduce the incidence of VTE, but to be optimally effective must consist of the correct choice of agent, at an appropriate dose, and for sufficient duration. Increasing evidence suggests that VTE risk persists beyond the standard period of prophylaxis. Although there is evidence that extended-duration prophylaxis is beneficial in preventing late VTE complications in high-risk surgical patients, few data exist in medical patients. The recent EXCLAIM study demonstrated that, subsequent to a standard prophylaxis regimen of 10 ± 4 days with enoxaparin 40 mg once daily, extended-duration prophylaxis (28 ± 4 days) with enoxaparin reduced total VTE events compared with placebo: 2.5% versus 4.0%; (absolute risk difference -1.53%; 95.8% confidence interval [CI] -2.54 to -0.52), with parallel increases in major bleeding rates (0.8% vs. 0.3%; absolute risk difference 0.51%; 95% CI 0.12-0.89%). The reduction in total VTE was principally driven by a decrease in symptomatic deep-vein thrombosis (absolute risk difference -0.60%; 95.8% CI -1.00 to -0.19%). Favorable benefit-to-risk ratios were observed in certain high-risk patient groups: level 1 immobility, women, and age >75 years. In addition to their underlying medical condition, medical patients often have multiple risk factors, placing them at sustained risk of VTE. Extended-duration prophylaxis might be most relevant in such patients. The development of appropriate risk assessment tools could help identify medical patients at greatest risk of late VTE events who might benefit most from extended-duration prophylaxis.

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Inpatient thromboprophylaxis use in U.S. hospitals: Adherence to the seventh American College of Chest Physician's recommendations for at‐risk medical and surgical patients

Abstract: Few medical and surgical patients at high risk of VTE receive appropriate inpatient prophylaxis in accordance with guideline recommendations. It is important for individual hospitals to improve VTE prophylaxis practices to meet national performance initiatives.

Cited by 62 publications

References 17 publications

Incidence rates for thromboembolic, bleeding and hepatic outcomes in patients undergoing hip or knee replacement surgery

Incidence rates for thromboembolic, bleeding and hepatic outcomes in patients undergoing hip or knee replacement surgery

Prevention of venous thromboembolism in cancer patients: current approaches and opportunities for improvement

Standard or extended-duration prophylaxis in medical patients? A review of the evidence

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