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Hospital‐acquired venous thromboembolism and prophylaxis in an integrated hospital delivery system
Author(s) -
Dorfman M.,
Chan S. B.,
Maslowski C.
Publication year - 2006
Publication title -
journal of clinical pharmacy and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.622
H-Index - 73
eISSN - 1365-2710
pISSN - 0269-4727
DOI - 10.1111/j.1365-2710.2006.00764.x
Subject(s) - medicine , pulmonary embolism , deep vein , warfarin , thrombosis , dosing , venous thrombosis , anticoagulant , chemoprophylaxis , surgery , pediatrics , atrial fibrillation
Summary Background: Without prophylaxis, hospital‐acquired deep vein thrombosis (DVT) is approximately 10–40% among medical or general surgical patients and thromboprophylaxis for high‐risk patients is currently recommended. This study analyse the risk factors associated with patients who developed a hospital‐acquired venous thromboembolism (VTE) and what prior prophylaxis, if any, were given to these patients. Methods: We identified 1 year of secondary VTE from seven metropolitan hospitals. A random sample was selected and reviewed retrospectively. Data abstracted included age, gender, VTE risk factors, surgeries, VTE prophylaxis, and anticoagulant dosing. Data analysis consisted of descriptive statistics. Results: A total of 118 patients with mean age 72·1 years (range 23–96) and 55·1% female. There were 60·2% DVT followed by 36·4% pulmonary embolism (PE); 7·6% had both DVT and PE diagnosed. About 73·7% of the study patients had two or more VTE risk factors. Five (4·2%) patients with hospital‐acquired VTE had no risk factors. Overall, 88·5% of patients with risk factors received adequate VTE prophylaxis; 20·3% received heparin or enoxaparin, 56·6% received warfarin, and 11·5% received mechanical prophylaxis secondary to drug contraindications. Nine (8·0%) patients with risk factors and no contraindications, did not received any prophylaxis while four patients (3·5%) received inadequate prophylaxis. All‐cause mortality was 13·6% (16/118). Conclusion: Less than 5% of hospital‐acquired VTE occurred in patients with no risk factors while 74% occurred in patients with two or more risk factors. In this seven‐hospital study, 11·5% of hospital‐acquired VTE with prior risk factors did not receive adequate prophylaxis. Educational in‐services on the new CHEST guidelines should be provided within the hospitals to increase adherence to prophylaxis guidelines.