Venous Thromboembolism Prophylaxis among Medical Patients at US Hospitals
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
Chemoprophylaxis is recommended for medical patients at moderate to high risk of venous thromboembolism (VTE) and is now a requirement of the Joint Commission on Accreditation of Healthcare Organizations. To see who receives prophylaxis and how far hospitals will need to go to meet this requirement, we examined VTE prophylaxis patterns at US hospitals.
We conducted a retrospective cohort study of adult patients with seven medical diagnoses considered to carry moderate to high risk of VTE at 376 acute care facilities in 2004–2005. We excluded patients on warfarin or with hospital stays of <2 days. VTE prophylaxis was assessed by billing codes for any heparin or compression device. We classified patient risk using a VTE risk prediction model.
Of 351,535 patients included, 36% received prophylaxis by hospital day 2. Prophylaxis rates were highest among patients with certain VTE risk factors, including mechanical ventilation (67%), restraints (57%), central lines (55%), obesity (46%), and prior VTE (44%). The median hospital rate was 31% (IQR 19% to 42%); only 3% of hospitals had rates >70%. Compared to patients at low risk of VTE (<0.05%), patients at high risk (>1.0%) were more likely to receive prophylaxis (52% vs. 34%, p < 0.001). Hospitals with high rates of prescribing for high-risk patients also had high rates for low-risk patients.
VTE prophylaxis rates at US hospitals are substantially below Joint Commission targets, even for patients at highest risk of VTE.
- Samama MM, Cohen AT, Darmon JY, et al. A comparison of enoxaparin with placebo for the prevention of venous thromboembolism in acutely ill medical patients. Prophylaxis in medical patients with enoxaparin study group. N Engl J Med. 1999;341:793–800. CrossRef
- Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism: American college of chest physicians evidence-based clinical practice guidelines (8th edition). Chest. 2008;133:381S–453S. CrossRef
- Wein L, Wein S, Haas SJ, Shaw J, Krum H. Pharmacological venous thromboembolism prophylaxis in hospitalized medical patients: A meta-analysis of randomized controlled trials. Arch Intern Med. 2007;167:1476–1486. CrossRef
- Stratton MA, Anderson FA, Bussey HI, et al. Prevention of venous thromboembolism: Adherence to the 1995 American college of chest physicians consensus guidelines for surgical patients. Arch Intern Med. 2000;160:334–340. CrossRef
- Keane MG, Ingenito EP, Goldhaber SZ. Utilization of venous thromboembolism prophylaxis in the medical intensive care unit. Chest. 1994;106:13–4. CrossRef
- Goldhaber SZ, Dunn K, MacDougall RC. New onset of venous thromboembolism among hospitalized patients at Brigham and Women’s Hospital is caused more often by prophylaxis failure than by withholding treatment. Chest. 2000;118:1680–4. CrossRef
- Tapson VF, Decousus H, Pini M, et al. Venous thromboembolism prophylaxis in acutely ill hospitalized medical patients: Findings from the international medical prevention registry on venous thromboembolism. Chest. 2007;132:936–45. CrossRef
- Cohen AT, Tapson VF, Bergmann JF, et al. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): A multinational cross-sectional study. Lancet. 2008;371:387–94. CrossRef
- The Joint Commission on the Accreditation of Healthcare Organizations. Venous Thromboembolism (VTE) Core Measure Set. 2009.
- Rothberg MB, Pekow PS, Liu F, et al. Potentially inappropriate medication use in hospitalized elders. J Hosp Med. 2008;3:91–102. CrossRef
- Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care. 1998;36:8–27. CrossRef
- Cook D, Tkaczyk A, Lutz K, McMullin J, Haynes RB, Douketis J. Thromboprophylaxis for hospitalized medical patients: A multicenter qualitative study. J Hosp Med. 2009;4:269–75. CrossRef
- Maynard G, Stein J. Preventing Hospital-Acquired Venous Thromboembolism: A Guide for Effective Quality Improvement. Rockville, MD: Agency for Healthcare Research and Quality; 2008.
- Dunn AS, Brenner A, Halm EA. The magnitude of an iatrogenic disorder: A systematic review of the incidence of venous thromboembolism for general medical inpatients. Thromb Haemost. 2006;95:758–62.
- Schuurman B, den Heijer M, Nijs AM. Thrombosis prophylaxis in hospitalised medical patients: Does prophylaxis in all patients make sense? Neth J Med. 2000;56:171–6. CrossRef
- Bergmann JF, Segrestaa JM, Caulin C. Prophylaxis against venous thromboembolism. BMJ. 1992;305:1156. CrossRef
- Venous Thromboembolism Prophylaxis among Medical Patients at US Hospitals
Journal of General Internal Medicine
Volume 25, Issue 6 , pp 489-494
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- venous thromboembolism (VTE)
- hospital mortality
- Industry Sectors
- Author Affiliations
- 1. Center for Quality of Care Research, Baystate Medical Center, Springfield, MA, USA
- 2. Division of General Medicine and Geriatrics, Baystate Medical Center, 759 Chestnut Street, Springfield, MA, 01199, USA
- 3. Department of Medicine, Tufts University School of Medicine, Boston, MA, USA
- 4. Department of Biostatistics, University of Massachusetts School of Public Health, Amherst, MA, USA