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Inappropriate prescription of low molecular weight heparins for thromboprophylaxis among older hospitalized patients

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Abstract

Aim

To investigate the prevalence and clinical correlates of overprescribing and underprescribing of low molecular weight heparins (LMWHs) for thromboprophylaxis among older medical inpatients.

Methods

Eight hundred seventy six patients (mean age 81.5 ± 7.6 years, female gender 57.2 %) enrolled in a multicenter observational study of seven acute care wards of geriatric medicine in Italy. The risk of venous thromboembolism was ascertained by calculating the Padua score for each patient. Patients receiving appropriate prescription of LMHW during stay were compared to those receiving LMHW with a Padua score <4 (overprescribing group). Similarly, patients with a high thromboembolic risk (Padua score ≥4) but not receiving LMHW (underprescribing group) were compared to patients appropriately not receiving LMHW during stay. Independent correlates of overprescribing and underprescribing were investigated by logistic regression analysis.

Results

Overall, 42.8 % of patients had a Padua score ≥4. LMWHs were overprescribed in 7.3 % and underprescribed in 25.2 % of patients. The number of lost basic activities of daily living (BADL) (OR = 0.25; 95 % CI 0.15–0.41) and the number of diagnoses (OR = 0.76; 95 % CI 0.61–0.95) were inversely associated with LMWH overprescription. Conversely, older age (75–84 years: OR = 2.39; 95 % CI 1.10–5.19—85 years or more: OR = 3.25, 95 % CI 1.40–7.61), anemia (OR = 1.80, 95 % CI 1.05–3.16), pressure sores (OR = 4.15, 95 % CI 1.20–14.3), number of lost BADL at the admission (OR = 3.92, 95 % CI 2.86–5.37) and number of diagnoses (OR = 1.29, 95 % CI 1.15–1.44) qualified as significant correlates of LMWH underprescription.

Discussion

Underprescription and, to a lesser extent, overprescription still represent an issue among older medical inpatients.

Conclusion

Implementing risk-stratifying scores into clinical practice may improve appropriateness of LMWHs prescribing during hospitalization.

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Acknowledgments

The study group CRIME: (Gemelli Hospital, Center of Aging Medicine, Catholic University of the Sacred Heart, Rome, Italy; University of Perugia, University of Ferrara, Italian National Research Center on Aging—INRCA situated in Ancona, Cosenza, Fermo, and Rome).

Author information

Authors and Affiliations

  1. Unit of Geriatric Pharmacoepidemiology, Research Hospital of Cosenza, Italian National Research Centre on Aging (INRCA), C. da Muoio Piccolo, 87100, Cosenza, Italy

    Sabrina Garasto, Sergio Fusco & Andrea Corsonello

  2. Center for Medicine of Aging, Policlinico A. Gemelli, University of Sacro Cuore, Rome, Italy

    Graziano Onder, Federica Sganga & Federica Mammarella

  3. Department of Science and Medicine, University of Ferrara, Ferrara, Italy

    Stefano Volpato

  4. Department of Medicine, Institute of Gerontology and Geriatrics, University of Perugia, Perugia, Italy

    Carmelinda Ruggiero

  5. Alzheimer’s Disease Clinic, ASL Frosinone, Atina, Italy

    Angela M. Abbatecola

  6. Scientific Direction, Italian National Research Center on Aging (INRCA), Ancona, Italy

    Fabrizia Lattanzio

Authors
  1. Sabrina Garasto
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  2. Sergio Fusco
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  3. Graziano Onder
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  4. Federica Sganga
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  5. Federica Mammarella
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  6. Stefano Volpato
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  7. Carmelinda Ruggiero
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  8. Angela M. Abbatecola
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  9. Fabrizia Lattanzio
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  10. Andrea Corsonello
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Corresponding author

Correspondence to Sergio Fusco.

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Conflict of interest

All authors declare that they have no conflict of interest.

Statement of human and animal rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. No animal experiments are included in this study.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Funding

The study was supported by the Italian Ministry of Health (Grants No. GR-2007-685638).

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Garasto, S., Fusco, S., Onder, G. et al. Inappropriate prescription of low molecular weight heparins for thromboprophylaxis among older hospitalized patients. Aging Clin Exp Res 29, 483–490 (2017). https://doi.org/10.1007/s40520-016-0571-0

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  • DOI: https://doi.org/10.1007/s40520-016-0571-0

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