Prophylaxis Against Venous Thromboembolism in Hospitalized Medically Ill Patients

Circ Cardiovasc Qual Outcomes. 2013 Jan 1;6(1):75-82. doi: 10.1161/CIRCOUTCOMES.112.965939. Epub 2013 Jan 8.

Abstract

Background: Many hospitalized medically ill patients are at risk of venous thromboembolism (VTE). Risk factors include prior VTE, older age, immobility, obesity, cardiac or respiratory failure, and cancer (at-risk patients). Although guidelines recommend use of VTE prophylaxis for at-risk patients, many may not receive it.

Methods and results: Using a database linking admission records from >150 US hospitals to health insurance claims, we identified people ≥40 years of age, hospitalized from 2003 to 2008. We excluded patients who: (1) were treated for VTE or hospitalized in the previous 30 days; (2) were admitted for traumatic injury or surgery; (3) had hypercoagulability at admission; or (4) received therapeutic dosages of low-molecular weight heparin, unfractionated heparin, or fondaparinux at admission. We examined the use of VTE prophylaxis (both pharmacological and nonpharmacological) on day 1 or 2 in hospital among at-risk patients; predictors of receipt of prophylaxis were examined using multivariate logistic regression. The study population consisted of 49 948 patients, of whom 34 374 (69%) were at risk. Only 18% of at-risk patients received VTE prophylaxis on day 1 or 2 in hospital, typically with low-molecular weight heparin (56% of patients receiving prophylaxis), intermittent pneumatic compression (25%), warfarin (16%), or graduated compression stockings (11%). Use of prophylaxis exceeded 25% only in patients admitted from nursing homes and those with prior VTE. Although there were several significant predictors of receipt of VTE prophylaxis, model discrimination was relatively poor (C-statistic=0.61).

Conclusion: The majority of at-risk hospitalized medically ill patients do not receive VTE prophylaxis.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anticoagulants / therapeutic use*
  • Female
  • Fibrinolytic Agents / therapeutic use*
  • Fondaparinux
  • Guideline Adherence*
  • Heparin / therapeutic use
  • Heparin, Low-Molecular-Weight / therapeutic use
  • Humans
  • Inpatients*
  • Intermittent Pneumatic Compression Devices / statistics & numerical data*
  • Male
  • Middle Aged
  • Polysaccharides / therapeutic use
  • Retrospective Studies
  • Risk Factors
  • Societies, Medical
  • United States / epidemiology
  • Venous Thromboembolism / epidemiology
  • Venous Thromboembolism / prevention & control*
  • Warfarin / therapeutic use

Substances

  • Anticoagulants
  • Fibrinolytic Agents
  • Heparin, Low-Molecular-Weight
  • Polysaccharides
  • Warfarin
  • Heparin
  • Fondaparinux