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Anticoagulation therapy in patients with venous thromboembolic disease

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Abstract

OBJECTIVE: To determine, in a representative sample of patients drawn from a variety of hospitals, the degree of adherence to consensus recommendations for anticoagulation among patients with deep vein thrombosis or pulmonary embolism.

DESIGN: Cross-sectional review of a population-based random sample.

SETTING: Twenty-one randomly selected Pennsylvania hospitals.

PATIENTS: Of 357 randomly selected Medicare beneficiaries discharged from study hospitals with a diagnosis of deep venous thrombosis or pulmonary embolism during 1992, 43 charts were not reviewed for administrative reasons, 31 were miscoded or not treated with intravenous administration of heparin, and 13 were excluded for other reasons, leaving 270 in the final sample.

MEASUREMENTS AND MAIN RESULTS: Overall, 179 patients (66%, 95% confidence interval [CI] 59%, 72%) received therapeutic anticoagulation (two consecutive partial thromboplastin times more than 1.5 times control) within 24 hours of starting heparin. Platelet counts were checked at least once during the first week of heparin therapy in 66% (95% CI 58%, 74%). At least 5 days of heparin therapy was given to 84% (95% CI 79%, 87%). Among 266 (99%) of the patients receiving warfarin, 193 (72%; 95% CI 63%, 80%) received heparin until the prothrombin time ratio or International Normalized Ratio was therapeutic. Patients who were started on warfarin therapy within 2 days of heparin had decreased length of stay (geometric mean 8.2 vs 9.7 days, p=.003). Compliance varied among hospitals.

CONCLUSIONS: In a wide variety of hospitals, we found fair, but variable, compliance with consensus recommendations for anticoagulation of patients with venous thromboembolic disease. Simple interventions to improve compliance with these recommendations might improve quality of care and reduce costs.

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Authors and Affiliations

  1. the Keystone Peer Review Organization, Harrisburg, Pa

    Jeff Whittle MD, MPH, Patti Johnson RN & A. Russell Locailo MPH, MS

  2. Section of General Internal Medicine, University of Pittsburgh, USA

    Jeff Whittle MD, MPH, Patti Johnson RN & A. Russell Locailo MPH, MS

  3. Pittsburgh VA Medical Center, USA

    Jeff Whittle MD, MPH

  4. Center for Biostatistics and Epidemiology, Pennsylvania State University, Hershey, USA

    A. Russell Locailo MPH, MS

Authors
  1. Jeff Whittle MD, MPH
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  2. Patti Johnson RN
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  3. A. Russell Locailo MPH, MS
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Additional information

The analyses on which this publication is based were performed Under contract 500-96-P708, entitled “Utilization and Quality Peer Review Organization for the Commonwealth of Pennsylvania,” sponsored by the Health Care Financing Administration, Department of Health and Human Services. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. The authors assume full responsibility for the accuracy and completeness of the ideas presented. This article is a direct result of the Health Care Quality Improvement Program initiated by the Health Care Financing Administration, which has encouraged identification of quality improvement projects derived from analysis of patterns of care, and therefore required no special funding on the part of this contractor. Ideas and contributions to the authors concerning experience in engaging with issues presented are welcomed.

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Whittle, J., Johnson, P. & Russell Locailo, A. Anticoagulation therapy in patients with venous thromboembolic disease. J GEN INTERN MED 13, 373–378 (1998). https://doi.org/10.1046/j.1525-1497.1998.00117.x

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  • DOI: https://doi.org/10.1046/j.1525-1497.1998.00117.x

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