Continuation of venous thromboembolism prophylaxis after hospital discharge into the outpatient setting: the ACCEPT study.

Abstract

Transition from the hospital into the outpatient setting is a critical event for the appropriate provision of VTE prophylaxis. Data for this transition for the situation in Germany is scant. This was a retrospective, observational study in patients receiving in-hospital thromboprophylaxis and discharged with or without a recommendation to continue. Patient with previous thromboembolism were excluded. A total of 3,211 patients were identified by 518 physicians of which 2,853 had all data available for the present analysis; mean patient's age was 57.4 ± 17.5 (SD) years, 48.2% were male and bodyweight was 79.8 ± 16.1 kg. During hospitalization 95.5% of surgical and 84.0% of medical patients received any thromboprophylaxis, the mean hospital duration being 12.7 ± 20.3 days. Surgical patients had high, medium and low risk in 53.8, 37.1 and 9.1%, respectively. Medical patients had high, medium and low risk in 78.8, 19.8 and 1.4%. A hospital recommendation to continue thromboprophylaxis was given to 84.6% (95% CI 83.1-85.9%) of surgical and 64.9% (95% CI 59.1-70.6%) of medical patients and implemented in 96.6 and 94.3%, respectively. On the other hand, in patients without a respective hospital recommendation (15.4% of surgical and 35.1% of medical patients), thromboprophylaxis was continued in 65.3% of surgical and 73.1% of medical patients because of high risk. Our data illustrate acceptable rates of prophylaxis in surgical and medical patients in Germany. As the results show, it is essential that not only hospital physicians are aware of the actual risk at discharge, but office based physicians assess thromboembolic risk.