Thromboprophylaxis rates in US medical centers: success or failure?

Abstract

Summary. Background: As hospitalized medical patients may be at risk of venous thromboembolism (VTE), evidence-based guidelines are available to help physicians assess patientsÕ risk for VTE, and to recommend prophylaxis options. The rate of appropriate thromboprophylaxis use in at-risk medical inpatients was assessed in accordance with the 6th American College of Chest Physicians (ACCP) guidelines. Methods: Hospital discharge information from the Premier Perspective TM inpatient data base from January 2002 to September 2005 was used. Included patients were 40 years old or more, with a length of hospital stay of 6 days or more, and had no contraindications for anticoagulation. The appropriateness of VTE thromboprophylaxis was determined in seven groups with acute medical conditions by comparing the daily thromboprophylaxis usage, including type of thromboprophylaxis, dosage of anticoagulant and duration of thromboprophylaxis, with the ACCP recommendations. Results: A total of 196 104 discharges from 227 hospitals met the inclusion criteria. The overall VTE thromboprophylaxis rate was 61.8%, although the appropriate thromboprophylaxis rate was only 33.9%. Of the 66.1% discharged patients who did not receive appropriate thromboprophylaxis, 38.4% received no prophylaxis, 4.7% received mechanical prophylaxis only, 6.3% received an inappropriate dosage, and 16.7% received an inappropriate prophylaxis duration based on ACCP recommendations. Conclusions: This study highlights the low rates of appropriate thromboprophylaxis in US acutecare hospitals, with two-thirds of discharged patients not receiving prophylaxis in accordance with the 6th ACCP guidelines. More effort is required to improve the use of appropriate thromboprophylaxis in accordance with the ACCP recommendations.

Applying Quality Measures and Guidelines in the Management of Acute Coronary Syndrome and Venous Thromboembolism

“…33 Results were similar when patients were stratified by disease or condition (myocardial infarction, heart failure, stroke, trauma, cancer, lung disease, spinal cord injury). These findings are consistent with the observations of other investigators.…”

“…The current ACC/AHA guidelines stipulate that if 8-12 hours have elapsed since the last subcutaneous dose of enoxaparin, an intravenous bolus dose of 0.3 mg per kg should be administered. 2,18,33 Experience from the OASIS-5 trial raised concerns about catheter-related thrombi in patients with NSTEMI or UA who received fondaparinux and underwent PCI. 27 Until more safety data become available, fondaparinux is unlikely to be widely used in the cardiac catheterization laboratory.…”

Mechanical and suboptimal pharmacologic prophylaxis and delayed mobilization but not morbid obesity are associated with venous thromboembolism after total knee arthroplasty: A case‐control study

“…Adherence to guidelines and use of prophylaxis may be higher at teaching hospitals than at nonteaching hospitals. 39 As a result, our sample may have less variation than the general population of TKA patients, limiting our power to detect associations between thromboprophylaxis and VTE. Finally, the case-control design has inherent limitations in detecting causal associations, largely due to its susceptibility to unmeasured confounders and incorrect ascertainment of pre-outcome exposures.…”

Pulmonary Embolism and Deep Vein Thrombosis

“…The biggest diffi culty in the specialty of in-hospital prophylaxis of venous thromboembolism is underuse of available prophylactic anticoagulant drugs. In a review 90 of almost 200 000 charts of US medical patients at moderate-risk or high-risk of venous thromboembolism who were admitted to hosiptal, appropriate prophylaxis for venous thromboembolism was ordered in only 34%. In a separate cohort study of patients admitted to hospital with deep vein thrombosis from 183 US institutions, the 2609 medical patients had more concomitant pulmonary embolism than did the 1953 non-medical patients with deep vein thrombosis (22% vs 16%).…”