Anticoagulation therapy for hospitalized patients: patterns of use, compliance with national guidelines, and performance on quality measures

Abstract

Purpose: The use of anticoagulant therapy for the prevention and treatment of venous thromboembolism (VTE) and acute coronary syndrome (ACS) among hospital inpatients was evaluated.

Methods: Medication-use data were retrospectively collected on 1716 patients who received anticoagulants for VTE or ACS at 42 community hospitals during the period April-June 2009; all hospitals in the sample were members of the same large health care organization. Descriptive analyses were performed to characterize anticoagulant use, patient safety, compliance with national prescribing guidelines, and performance on relevant Joint Commission quality measures.

Results: The most common indications for anticoagulant use were VTE prophylaxis (67.5% of cases), ACS (13.5% of cases), and VTE treatment (11.9% of cases). The agents most commonly used for VTE prophylaxis were subcutaneous enoxaparin (70% of cases) and subcutaneous unfractionated heparin (UFH). Overall, the anticoagulant regimen used was consistent with national prescribing guidelines in 67.5% of cases; however, rates of appropriate prescribing were lower in subgroups of patients with renal impairment, obesity, or both (63.6%, 42.5%, and 63.6%, respectively). Reported anticoagulant-related adverse events during the study period mainly involved minor or major bleeding, which occurred in 36% and 32% of cases, respectively. Compliance with Joint Commission core measures ranged from 49.1% for core measure VTE-3 (warfarin overlap therapy) to 72.3% for VTE-4 (monitoring of UFH dosages and platelet counts by protocol).

Conclusion: Among hospitals in a large national health care system, the most common use of anticoagulants in hospitalized patients was for VTE prevention, followed by ACS and VTE treatment. Enoxaparin and UFH were the most commonly used agents for each indication, and the selection and use of anticoagulants were in compliance with national guidelines in the majority of patients for whom those drugs were prescribed.