Journal of Thrombosis and Thrombolysis

, Volume 25, Issue 2, pp 160–164

Frequency of thromboprophylaxis and incidence of in-hospital venous thromboembolism in a cohort of emergency department patients

  • Alan E. Jones
  • Zachary Fordham
  • Vasilios Yiannibas
  • Charles L. Johnson
  • Jeffrey A. Kline
Article

Abstract

Objective

Prior work suggests that in-hospital pulmonary and venous thromboembolism (VTE) could be decreased if the rate of prophylaxis for VTE in high-risk patients were increased at the time of admission. Our objective was to quantify the rate of thromboprophylaxis and incidence of in-hospital VTE, based upon risk of VTE, in a cohort of patients admitted through the emergency department (ED).

Methods

We performed a prospective cohort study at an urban ED with >100,000 visits. All medical patients >17 years admitted from the ED were prospectively identified on a random sample of days for one year. Using a structured data form we collected each patient’s risk factors for VTE, and prophylaxis measures. We computed a validated risk score of each patient, with a score ≥4 high-risk (HR) and a score <4 low risk (LR). The main outcome was VTE during the hospitalization, diagnosed after admission from ED.

Results

Of 4732 patients, VTE was diagnosed during hospitalization in 44 (0.9%). 437 (9%) patients were HR for VTE and HR patients had significantly higher frequency of VTE vs. LR patients, 1.8 vs. 0.8% (95% CI for difference of 1% = 0.1–3%). Only 36% of HR patients received thromboprophylaxis. There were no significant differences in the frequency of observed inpatient VTE events between patients who were prescribed prophylaxis compared with those who were not prescribed prophylaxis in either risk group.

Conclusion

These data suggest only a modest opportunity for ED-based policy for thromboprophylaxis in admitted medical patients.

Keywords

Deep venous thrombosis Prophylaxis Pulmonary embolism Emergency department 

References

  1. 1.
    Committee on Quality Institute of Medicine and Institute of Medicine. To Err is Human. Building a Safer Health System. Kohn, L., Corrigan, J., and Donaldson, M. 15–21. 1999. National Acadamy Press. Quality of Health Care in AmericaGoogle Scholar
  2. 2.
    Shojania KG, Duncan BW, McDonald KM et al (2001) Making health care safer: a critical analysis of patient safety practices. Evid Rep Technol Assess (Summ) 43:i–668Google Scholar
  3. 3.
    Leizorovicz A, Cohen AT, Turpie AG et al (2004) Randomized, placebo-controlled trial of dalteparin for the prevention of venous thromboembolism in acutely ill medical patients. Circulation 110:874–879PubMedCrossRefGoogle Scholar
  4. 4.
    Geerts WH, Pineo GF, Heit JA et al (2004) Prevention of venous thromboembolism: the seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest 126(3 Suppl):338S–400SPubMedCrossRefGoogle Scholar
  5. 5.
    McCaig LF, Burt CW (2004) National Hospital Ambulatory Medical Care Survey: 2002 emergency department summary. Advance Data (340):1–34Google Scholar
  6. 6.
    Kucher N, Koo S, Quiroz R et al (2005) Electronic alerts to prevent venous thromboembolism among hospitalized patients. N Engl J Med 352(10):969–977PubMedCrossRefGoogle Scholar
  7. 7.
    Kline JA, Johnson CL, Webb WB, Runyon MS. (2005) Prospective study of clinician-entered research data in the Emergency Department using an internet-based system after the HIPAA Privacy Rule. BMC Med Inform Decision Making 2004. 4(Oct 12):17–25Google Scholar
  8. 8.
    Kahn SR, Panju A, Geerts W et al (2007) Multicenter evaluation of the use of venous thrmoboembolism prophylaxis in acutely ill medical patients in Canada. Thromb Res 119:145–155PubMedCrossRefGoogle Scholar
  9. 9.
    Peterman CM, Kolansky DM, Spinler SA (2006) Prophylaxis against venous thromboembolism in acutely ill medical patients: an observational study. Pharmacotherapy 26:1086–1090PubMedCrossRefGoogle Scholar
  10. 10.
    Pineda LA, Hathwar VS, Grant BJB (2001) Clinical suspicion of fatal pulmonary embolism. Chest 120:791–795PubMedCrossRefGoogle Scholar
  11. 11.
    Stein PD, Henry JW (1995) Prevalence of acute pulmonary embolism among patients in a general hospital and at autopsy. Chest 108:978–981PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Alan E. Jones
    • 1
  • Zachary Fordham
    • 2
  • Vasilios Yiannibas
    • 1
  • Charles L. Johnson
    • 1
  • Jeffrey A. Kline
    • 1
  1. 1.Department of Emergency Medicine, Emergency Medicine ResearchCarolinas Medical CenterCharlotteUSA
  2. 2.University of Mississippi School of MedicineJacksonUSA

Personalised recommendations