Deep vein thrombosis prophylaxis in a tertiary care center: An observational study

Abstract

Abstract Background Deep vein thrombosis (DVT) is a major health problem with substantial mortality and morbidity in medically ill patients. Prevention of DVT by risk factor stratification and subsequent antithrombotic prophylaxis in moderate- to severe-risk category patients is the most rational means of reducing morbidity and mortality. Objective To study the management strategies for DVT prophylaxis in a tertiary care center and evaluate the prophylactic dosing patterns for DVT prevention. Methods A prospective, observational study was performed in the intensive care units and medical wards of a tertiary care center. A structured proforma was designed for risk assessment and stratification of DVT in critically ill patients with recommended thromboprophylaxis. The dosing patterns of all medications given for DVT prophylaxis were analyzed for their appropriateness according to 8th ACCP guidelines. Results A total of 480 patient charts were reviewed. It was observed that 358 patients (74.6%) were on mixed prophylaxis, 38 patients (18.5%) were on pharmacological prophylaxis, and 33 patients (6.9%) were on mechanical prophylaxis only. Enoxaparin and graduated compression stockings were the most commonly used pharmacological and mechanical prophylaxes, respectively. The prophylaxis guidelines were followed in 77% of the study population. The reasons for inappropriate dosing patterns were found to be subtherapeutic dosing and overdosing. Conclusions Our study revealed that a higher proportion of the patients who are at high risk are currently given thromboprophylaxis as per the standard prophylactic recommendations. There is still considerable scope for improvement in the management of DVT in all units of the institution.