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Circ Cardiovasc Qual Outcomes. 2013 Jan 1;6(1):75-82. doi: 10.1161/CIRCOUTCOMES.112.965939. Epub 2013 Jan 8.

Prophylaxis against venous thromboembolism in hospitalized medically ill patients.

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  • 1Policy Analysis Inc, Four Davis Ct, Brookline, MA 02445, USA.

Abstract

BACKGROUND:

Many hospitalized medically ill patients are at risk of venous thromboembolism (VTE). Risk factors include prior VTE, older age, immobility, obesity, cardiac or respiratory failure, and cancer (at-risk patients). Although guidelines recommend use of VTE prophylaxis for at-risk patients, many may not receive it.

METHODS AND RESULTS:

Using a database linking admission records from >150 US hospitals to health insurance claims, we identified people ≥40 years of age, hospitalized from 2003 to 2008. We excluded patients who: (1) were treated for VTE or hospitalized in the previous 30 days; (2) were admitted for traumatic injury or surgery; (3) had hypercoagulability at admission; or (4) received therapeutic dosages of low-molecular weight heparin, unfractionated heparin, or fondaparinux at admission. We examined the use of VTE prophylaxis (both pharmacological and nonpharmacological) on day 1 or 2 in hospital among at-risk patients; predictors of receipt of prophylaxis were examined using multivariate logistic regression. The study population consisted of 49 948 patients, of whom 34 374 (69%) were at risk. Only 18% of at-risk patients received VTE prophylaxis on day 1 or 2 in hospital, typically with low-molecular weight heparin (56% of patients receiving prophylaxis), intermittent pneumatic compression (25%), warfarin (16%), or graduated compression stockings (11%). Use of prophylaxis exceeded 25% only in patients admitted from nursing homes and those with prior VTE. Although there were several significant predictors of receipt of VTE prophylaxis, model discrimination was relatively poor (C-statistic=0.61).

CONCLUSION:

The majority of at-risk hospitalized medically ill patients do not receive VTE prophylaxis.

PMID:
23300270
DOI:
10.1161/CIRCOUTCOMES.112.965939
[PubMed - indexed for MEDLINE]
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