S3219 Venous Thromboembolism Prophylaxis Adherence Rates in Hospitalized Inflammatory Bowel Patients at an Academic Medical Center

Abstract

INTRODUCTION: Inflammatory Bowel Disease (IBD) is comprised of two distinct disorders: Crohn’s Disease (CD) and Ulcerative Colitis (UC). They are chronic inflammatory diseases that primarily affect the gastrointestinal (GI) tract, but they can also cause extraintestinal complications. Venous thromboembolism (VTE) is particularly prevalent in IBD patients (IBDP), especially during disease flares, and is associated with high risk of morbidity and mortality. However, IBDP also have a propensity for GI bleeding during IBD exacerbations. With risk for both VTE and GI bleed, the decision to start VTE prophylaxis (VTEP) in hospitalized IBD patients poses a conundrum. The American College of Chest Physicians currently recommends such patients receive VTEP as data from numerous randomized controlled trials demonstrates VTEP is not associated with major adverse events in IBDP. The goal of this study was to evaluate the rate of VTEP at our hospital. METHODS: A retrospective chart review was conducted following all IBDP admitted to Wake Forest Baptist Medical Center from 1/2019 to 6/2019. 150 patients were identified. Demographics, admission diagnosis, admission medications, presenting symptoms, and medical history were collected. RESULTS: Of the 150 IBDP, 57% received VTEP on admission. In admissions related to IBD (37%), 18.2% received VTEP, whereas in non-IBD related complaints 79% received VTEP. Among patients endorsing hematochezia on admission (15%), 22% received VTEP. Of the patients with a history of GI bleed (65%), 47% received VTEP. 50% of patients with a history of VTE (12%), received VTEP. Odds ratio estimates showed IBD related admissions, hematochezia, and history of GI bleed were negatively associated with VTEP. CONCLUSION: Our analysis demonstrated a statistically significant decrease in administration of VTEP in patients admitted for an IBD related complaint, patients endorsing hematochezia, and patients with a history of GI bleed. This shows a major deficit in our hospital’s adherence to the ACCP guidelines of VTEP administration to all IBDP admitted to the hospital. Future directions of these findings include implementation of a Best Practice Advisory (BPA) into the electronic medical record to encourage VTEP for IBDP. After a trial of this BPA, a similar analysis will be repeated to evaluate the efficacy of the measure.Figure 1