Has the Pendulum Swung Too Far? Evaluation of the Appropriate Use of VTE Prophylaxis for Medical Inpatients

Abstract

SESSION TITLE: Practice Management SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM PURPOSE: Venous thromboembolism (VTE) is the most common cause of hospital death. However, studies have not been able to show a consistent benefit of VTE prophylaxis on mortality in hospitalized medical patients. Medical inpatients are a very heterogenous group; not all of them need VTE prophylaxis. Several risk assessment modules including the Padua Prediction Score, attempt to identify patients at high-risk for thromboembolism. The goal of the study was to evaluate if risk is assessed and defined by clinicians prior to prescribing VTE prophylaxis. METHODS: A retrospective chart analysis was performed for patients admitted to the medicine service from January 2015 to June 2015. The initial arrival orders as well as the history and physical documented by the admitting physician were reviewed to determine if the risk of VTE was recorded and if VTE prophylaxis was prescribed. Patients were stratified as either admission or observation and the type of anticoagulation was recorded. If the admitting physician did not perform a VTE risk assessment, risk of VTE was calculated using the Padua Prediction Score. RESULTS: Of the 648 patients, 314 (48%) and 334 (52%) met admission and observation criteria, respectively. Chemical VTE prophylaxis was prescribed for 262 of the 314 (83%) admissions and 215 of the 334 (64%) observation patients. Of the 262 admissions that received chemical VTE prophylaxis, 240 (92%) of these patients were considered low-risk based on the Padua Prediction Score. 201 of the 215 (93%) observation patients that received chemical VTE prophylaxis were calculated to be low-risk. Adverse events were found to occur in 7 of the 648 (1.1%) patients that received chemical VTE prophylaxis. CONCLUSIONS: Despite an overall improvement in VTE prevention, inappropriate use of chemical VTE prophylaxis was observed in a majority of medical inpatients. CLINICAL IMPLICATIONS: Most clinicians do not perform a proper risk assessment for thromboembolism and bleeding prior to the initiation of VTE prophylaxis. Although the complication rate was low, further studies are needed to address additional negative consequences from the overuse of anticoagulation such as cost, nursing time and patient discomfort. DISCLOSURE: The following authors have nothing to disclose: Courtney Fay No Product/Research Disclosure Information