Abstract
Background
Venous thromboembolic disease (VTED) prophylaxis is a key strategy in reducing preventable deaths in medical inpatients. We assessed compliance with internationally published guidelines for VTED prophylaxis in at-risk medical patients before and 1 month after an educational intervention to enhance compliance with such guidelines.
Results
One hundred and fifty patients were assessed on each occasion. Pre-intervention, VTED prophylaxis was prescribed in only 48% of at-risk cases. Compliance was best among patients under stroke services and worst for those under acute medical teams. Patients within specialist units were more likely to be prescribed prophylaxis than those in general wards (75 vs. 53%; p = 0.0019). Post-intervention, overall compliance improved to 63% (p = 0.041 for comparison). There was a significant improvement among general medical teams (48 vs. 75%; p = 0.001), and in general wards (52 vs. 74%; p = 0.003).
Conclusions
Thromboprophylaxis is under-prescribed in medical inpatients, but compliance with international guidelines can be significantly enhanced with targeted educational intervention.
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References
Francis CW (2007) Clinical practice. Prophylaxis for thromboembolism in hospitalized medical patients. N Engl J Med 356(14):1438–1444
Samama MM, Cohen AT, Darmon JY et al (1999) 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 341(11):793–800
Dentali F, Douketis JD, Gianni M, Lim W, Crowther MA (2007) Meta-analysis: anticoagulant prophylaxis to prevent symptomatic venous thromboembolism in hospitalized medical patients. Ann Intern Med 146(4):278–288
Avorn J, Winkelmayer WC (2004) Comparing the costs, risks, and benefits of competing strategies for the primary prevention of venous thromboembolism. Circulation 110(24 Suppl 1):IV25–IV32
Geerts WH, Bergqvist D, Pineo GF et al (2008) Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th edition). Chest 133(6 Suppl):381S–453S
Cohen AT, Tapson VF, Bergmann JF et al (2008) Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet 371(9610):387–394
Tooher R, Middleton P, Pham C et al (2005) A systematic review of strategies to improve prophylaxis for venous thromboembolism in hospitals. Ann Surg 241(3):397–415
Kelly J, Rudd A, Lewis R, Hunt BJ (2001) Venous thromboembolism after acute stroke. Stroke 32(1):262–267
Sherman DG, Albers GW, Bladin C et al (2007) The efficacy and safety of enoxaparin versus unfractionated heparin for the prevention of venous thromboembolism after acute ischaemic stroke (PREVAIL Study): an open-label randomised comparison. Lancet 369(9570):1347–1355
Dennis M, Sandercock PA, Reid J et al (2009) Effectiveness of thigh-length graduated compression stockings to reduce the risk of deep vein thrombosis after stroke (CLOTS trial 1): a multicentre, randomised controlled trial. Lancet 373(9679):1958–1965
Cohen AT, Alikhan R, Arcelus JI et al (2005) Assessment of venous thromboembolism risk and the benefits of thromboprophylaxis in medical patients. Thromb Haemost 94(4):750–759
Kahn SR, Panju A, Geerts W et al (2007) Multicenter evaluation of the use of venous thromboembolism prophylaxis in acutely ill medical patients in Canada. Thromb Res 119(2):145–155
Rashid ST, Thursz MR, Razvi NA et al (2005) Venous thromboprophylaxis in UK medical inpatients. J R Soc Med 98(11):507–512
Kucher N, Koo S, Quiroz R et al (2005) Electronic alerts to prevent venous thromboembolism among hospitalized patients. N Engl J Med 352(10):969–977
Timmons S, O’Callaghan C, O’Connor M, O’Mahony D, Twomey C (2005) Audit-guided action can improve the compliance with thromboembolic prophylaxis prescribing to hospitalized, acutely ill older adults. J Thromb Haemost 3(9):2112–2113
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Kent, B.D., Nadarajan, P., Akasheh, N.B. et al. Improving venous thromboembolic disease prophylaxis in medical inpatients: a role for education and audit. Ir J Med Sci 180, 163–166 (2011). https://doi.org/10.1007/s11845-010-0619-7
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DOI: https://doi.org/10.1007/s11845-010-0619-7