Physicians’ compliance with the Padua Prediction Score for preventing venous thromboembolism among hospitalized medical patients

Abstract

To cite this article: Rossetto V, Barbar S, Vedovetto V, Milan M, Prandoni P. Physicians' compliance with the Padua Prediction Score for preventing venous thromboembolism among hospitalized medical patients. J Thromb Haemost 2013; 11: 1428-30.Hospitalization for acute medical illnesses confers an 8-fold increased risk of venous thromboembolic (VTE) disorders that persists for up to 3 months and is even higher after discharge than during in-hospital stay [1]. However, in spite of strong evidence in favor of thromboprophylaxis [2][3][4], several observation studies from various countries found that less than 50% of admitted medical patients at risk receive prophylaxis against VTE [5][6][7][8].We have recently identified and validated a suitable and effective risk assessment model, the Padua Prediction Score (PPS), for optimal stratification of the thrombotic risk in hospitalized medical patients [9]. Its implementation in the Departments of Internal Medicine has recently been suggested by the latest ACCP consensus guidelines [10]. For the purpose of that investigation, attending physicians were not informed about the thrombotic risk of their patients and, as a result, less than 40% managed their patients correctly [9].In an attempt to assess whether awareness of the thrombotic risk -as assessed with the PPS -has the potential to increase the rate of appropriate thromboprophylaxis in high-risk medical patients, we performed a second prospective investigation within the same framework as the first. On this occasion, we alerted the attending physicians to the thrombotic risk of their patients by tracing a well visible red line on the clinical chart of those who were at high risk. In addition, for further confirmation that the adoption of the PPS has the potential to improve patients' outcome, we registered the thrombotic and hemorrhagic events occurring up to 90 days after recruitment in the high-risk patients. Any decisions concerning use and timing of prophylaxis were left to the discretion of the attending physicians. The investigation was approved by the Ethical Board of the University Hospital of Padua.Out of 1600 consecutive patients admitted to the Second Division of Internal Medicine of the University Hospital of Padua (Italy) between January 2010 and December 2011, 797 were excluded due to indications for anticoagulant treatment (740), contraindications for pharmacological prophylaxis (40), failure to give informed consent (10) or difficulties in obtaining follow-up information (8). Accordingly, 803 patients were recruited, of whom 296 (39.6%) were at high risk and 507 at low risk of VTE based on the PPS. Table 1 shows the main clinical features of the high-risk patients. Consistent with the previous investigation [8], prescriptions were regarded as adequate if enoxaparin 4000 U, dalteparin 5000 U or fondaparinux 2.5 mg were administered once a day within 48 h of hospital admission and for at least 80% of the hospital stay. Of the 296 high-risk patients, 262 (88.5%) received adequate pharmacological prophyla...

Use of thromboprophylaxis for venous thromboembolism among patients admitted in medical ward

“…This is similar to the Italian study which showed most common risk factor was reduced mobility, advanced age, cardiac/respiratory failure and acute infection/rheumatological disorder. 14 Reduced mobility was the most common risk factor which might be due to our deeply rooted cultural practices that anyone who is admitted in hospital should take rest and lie in the bed most of the time.…”

Heparins for preventing venous thromboembolism in general medical wards: evidence and guidelines

“…Most often, it is inexperienced junior medical staff who assess patients and prescribe prophylaxis, and they would benefit from explicit and validated risk assessment models. Several models have been derived from large clinical databases (two are favoured by the ACCP), and although some have been partly validated, it remains likely that none will be very precise. Medical patient VTE prophylaxis remains a challenge because the benefit and risk of anticoagulant prophylaxis will differ between individuals, and because of the need to translate complex decision trees into routine clinical practice.…”

Scoring Systems for Estimating Risk of Venous Thromboembolism in Hospitalized Medical Patients

“…In a subsequent study, PPS demonstrated a good physicians' compliance: the awareness of the thrombotic risk-as assessed with the PPS-increased the rate of prescription of appropriate prophylaxis in high-risk medical patients from 39.6% of the previous study 29 up to 88.5% (p < 0.0001). 30 PPS was recommended by the ACCP guidelines in 2012 for VTE risk assessment in medical hospitalized patients. 15 The Geneva score and PPS have been prospectively validated in a cohort of 1,478 acutely ill medical patients enrolled in three academic and five nonacademic acute care hospitals in Switzerland.…”