Venous Thromboembolism Prophylaxis for Medical Patients

Epidemiology of venous thromboembolism

“…140–146 Although risk-assessment models have been derived for prediction of VTE in hospitalized, nonsurgical patients, these models are highly variable in terms of the number and type of predictors, and the strengths of associations with VTE, and lack generalizability and adequate validation. 147,148 …”

Impact of a Multicenter, Mentored Quality Collaborative on Hospital‐Associated Venous Thromboembolism

“…4,5 Several of these are point scoring systems, which may have lower clinician acceptance or require programming to improve real-world use 18,26,27 ; the Padua score was derived from a patient population that differs significantly from those in the United States. 12 Our study provides more practical experience with a "3-bucket" model, which has previously shown high interobserver reliability, good clinician acceptance, and meaningful reductions of VTE, including in American patient populations. 18,22,24 The value of VTE prophylaxis is still disputed in many inpatient groups.…”

“…17,18 The selection of a VTE protocol conducive to implementation and provider use was a key strategy. The ideal approach to VTE risk assessment is not known, 12,26 but guidelines either offer no specific guidance 7 or would require implementation of 3 different systems per hospital. 4,5 Several of these are point scoring systems, which may have lower clinician acceptance or require programming to improve real-world use 18,26,27 ; the Padua score was derived from a patient population that differs significantly from those in the United States.…”

“…The overall rate of HA-VTE is low, so the per-patient benefit of prophylaxis is low, and many patients may be overprophylaxed. 4,11,12 Recently, Flanders et al 20 reported that HA-VTE rates among 20,800 medical inpatients in Michigan were low (about 1%) and similar at hospitals in the top (mean prophylaxis rate 86%) or bottom (mean prophylaxis rate 56%) tertiles of performance. Possible explanations for the differences between their multicenter experience and ours include our sample size (55 times larger) and the possibility that targeting prophylaxis to patients at highest need (captured in our protocol-compliant prophylaxis rates) matters more than prophylaxing a percent of the population.…”

“…Further research is needed to develop simple, easy-to-im-plement methods to identify inpatients who do not, or no longer, require prophylaxis. 12 Hospital systems also need methods to determine if prophylaxis improvement efforts can lower their HA-VTE rates and in which subpopulations. For example, a collaborative effort at the University of California lowered HA-VTE rates toward a common improved rate of 0.65% to 0.73%, 22 while Dignity Health achieved improvement despite starting with an even lower baseline.…”