The epidemiology of venous thromboembolic events in a severe trauma cohort admitted to the intensive care unit of an Australian major trauma centre over a five-year period.

Patient-controlled epidural analgesia (PCEA) decreases the amount of systemic opioid required for adequate analgesia and decreases the rate of opioid-induced adverse effects. Given the location of catheters required to deliver analgesics and the potential for epidural hematoma, the American Society of Regional Anesthesia and Pain Medicine recommends modification of the standard trauma venous thromboembolism (VTE) prophylaxis regimen of enoxaparin 30 mg twice daily to 40 mg daily. The objective of this retrospective study was to determine if 40-mg daily dosing would increase the incidence of VTE. With institutional review board approval, records of all combat casualties admitted to our institution between November 2010 and November 2012 were reviewed for demographics, VTE prophylaxis regimen, PCEA days, and incidence of VTE. Patients who arrived without VTE were the study cohort. Rates of VTE were compared between PCEA and no-PCEA groups. Variables were analyzed with Mann-Whitney U-test, Pearson's χ test, and Fisher's exact test. A p ≤ 0.05 was considered significant. Data are expressed as median (interquartile range). A total of 565 records were reviewed; 484 met inclusion criteria; and 181 patients (37.4%) had PCEA for 13 days (6-25 days). Age and sex were similar between the groups. PCEA patients were more often injured by dismounted improvised explosive devices (75.1% vs. 39.3%, p < 0.001), had longer hospital stays (38 days vs. 17 days, p < 0.001), had higher Injury Severity Score (ISS) (14 vs. 12, p = 0.033), and were more likely to have an amputation (66.1% vs. 20.4%, p < 0.001). Twenty-three PCEA patients (12.7%) developed VTE versus 32 no-PCEA patients (10.6%) (p = 0.464). Eleven VTE events (47.8%) occurred with the catheter in place, while 12 VTE events (52.2%) occurred 6 days (2-15 days) after removal. Although PCEA catheters were more often placed in patients prone to VTE, there was no difference in incidence of VTE with their use. These data suggest that enoxaparin 40 mg daily in patients with PCEA is not inferior to 30 mg twice daily for VTE prophylaxis in combat-wounded patients. Therapeutic study, level IV.

Coagulopathy Does Not Protect Against Venous Thromboembolism in Hospitalized Patients With Chronic Liver Disease

IntroductionBurn patients are at a heightened risk of venous thromboembolism (VTE). This study aimed to evaluate the impact of a standardized VTE prophylaxis protocol on VTE incidence and major bleeding rates in burn patients.MethodsA retrospective observational study was conducted, including adult burn patients admitted to a burn center over a 28-month period. The protocol mandated enoxaparin 40 mg twice daily for patients with ≥ 20% total body surface area (TBSA) burns weighing at least 40kg, or a BMI ≥ 40. Dose adjustments were calculated based on anti-Xa levels. The primary outcome was the comparison of VTE incidence before and after protocol implementation. The primary safety endpoint was major bleeding. Secondary outcomes included subgroup analysis by TBSA, VTE prophylaxis type, and protocol eligibility.ResultsA total of 263 patients were included (pre-protocol: 118, post-protocol: 145). The overall VTE incidence was 2.5% pre-protocol and 4.1% post-protocol (P=0.521). Major bleeding occurred in 3.4% of pre-protocol and 2.8% of post-protocol patients (P=1.0). Subgroup analyses based on TBSA, VTE prophylaxis type, and protocol eligibility did not reveal statistically significant differences in VTE incidence.ConclusionsImplementation of the VTE prophylaxis protocol did not result in a statistically significant reduction in VTE incidence compared to prior standard care, despite a trend towards increased dose consistency. Further research is warranted to optimize VTE prophylaxis strategies in this high-risk patient population. Ongoing efforts are focused on evaluating protocol adherence and minimizing interruptions in prophylaxis to potentially improve outcomes.Applicability of Research to PracticeThe optimal VTE prophylaxis in burn patients remains unknown. Although enoxaparin 40 mg twice daily has emerged as the most widely recommended dose, it is unknown which burn patients should utilize this dose. This study evaluates the efficacy and safety of a novel VTE prophylaxis protocol for burn patients. Although this current study did not show a reduction in VTE events, it hopefully brings the burn population one step closer to finding the ideal VTE prophylaxis. Further stratification of the data could be strengthened by employing a larger cohort to investigate co-morbidities, the extent of immobilization, and the incidence of VTE associated with line placements.Funding for the StudyN/A

Objective: To determine the risk profile of venous thromboembolism (VTE) and evaluate VTE prophylaxis implementation of the hospitalized cancer patients in the DissolVE 2 study. Methods: The data of hospitalized cancer patients in the DissolVE 2 study were analyzed. The risk distribution of VTE, preventive measures and in-hospital VTE events of hospitalized patients with tumors were described by percentage and 95% confident interval (CI). Results: A total of 1 535 cancer patients were included. According to the Padua score, 826 (53.8%) patients were at low risk of VTE, while 709 (46.2%) patients were at high VTE risk. VTE events occurred in 4 low-risk patients (0.5%; 95%CI: 0.1%, 1.2%) and 5 high-risk patients (0.7%; 95%CI: 0.2%, 1.6%). The overall incidence was 0.6% (9/1 535, 95%CI: 0.3%, 1.1%). Among patients with high VTE risk, 666 (93.9%) did not receive any VTE prophylaxis, and only 11 (1.6%) patients received appropriate VTE prophylaxis. Among patients who received VTE prevention, no VTE event was observed. Conclusions: Nearly half of the hospitalized cancer patients are at high risk of VTE, but most of them don't receive VTE prophylaxis. The results reflect the insufficient management of VTE risk for hospitalized cancer patients in China, and improvement of awareness and practice of VTE prophylaxis is urgently needed.

To measure the per-event health plan costs for acute and follow-up treatment not directed by a clinical study protocol in a group of commercially insured patients in 2 managed care organizations following an incident hospitalization that included a diagnosis for a venous thromboembolism (VTE) event. A cohort of patients with an incident in-hospital VTE event, consisting of deep vein thrombosis (DVT), or pulmonary embolism (PE), or both DVT + PE, was retrospectively identified from the administrative claims databases of 2 large U.S. health care plans. Inclusion criteria were (a) an inpatient VTE event between January 1, 1998, and December 31, 2000, (b) no VTE diagnosis or anticoagulation therapy 3 months prior to the incident VTE in-hospital event, (c) at least 1 anticoagulation pharmacy fill following the incident hospital VTE, and (d) continuous health plan enrollment 3 months prior to and 6 months following the incident hospital VTE event. Total costs were reported on a per-event basis and consisted of the aggregated amount paid by the health plan to the provider after subtraction of member cost-share. Costs were collected separately, first for the incident VTE event for all patients identified and second for patients who had at least 1 of the following events in the follow-up period: bleed requiring or not requiring hospitalization, a recurrent VTE event requiring hospitalization, or a recurrent VTE and bleed (VTE + bleed) event requiring hospitalization. Costs were compared between incident diagnosis groups using multivariate generalized linear model techniques. A total of 2,147 patients (DVT=1,499 [69.8%], PE=373 [17.4%], DVT+PE= 275 [12.8%]) were identified (mean age=61.6standard deviation [SD] 16 years; 46.3% male) and were followed for an average of 21.3 (median, 19.2) months. Disease severity was high in these patients, including 59.2% with a history of or active malignancy. The prevalence of VTE was 2.04 per 100,000 study-eligible health plan members. For the incident VTE events, average costs were 7,712+/-18,339 US dollars (median, 3,131 US dollars) per incident DVT event; 9,566+/-13,512 US dollars (median, 6,424 US dollars) per PE incident event; and 12,200+/-24,038 US dollars (median, 6,678 US dollars) per incident DVT+PE event. Warfarin treatment following the incident VTE event was administered to 97.3% of patients for an average of 6.7 (median, 5.0) months at an average cost of 19.40 US dollars per patient per month. During the average period of 21.3 months, 534 patients (24.9%) experienced an average of 1.24 bleed or recurrent VTE events per patient that required hospitalization at a mean cost of 14,975 US dollars per event or 2,101 US dollars per patient per year. For patients with a bleed in the follow-up period that required hospitalization, average costs were 12,326+/-24,448 US dollars (median, 5,736 US dollars) per recurrent VTE; 15,339+/-52,029 US dollars (median, 4,999 US dollars) per bleed; or 24,085+/-65,411 US dollars (median, 10,185 US dollars) per recurrent VTE + bleed event. During the follow-up period, a total of 612 patients (28.5%) experienced 1,489 recurrent bleed events that did not require hospitalization, at an average cost of 239+/-386 US dollars (median, 95 US dollars) per event. There were no significant differences in mean total costs for all pair-wise comparisons between the 3 incident diagnosis groups. Of patients who experienced a VTE event during the incident hospital stay for any diagnosis, 1 in 4 experienced an average of 1.24 bleed or recurrent VTE events that required hospitalization in the 21 months of follow-up and incurred an average health plan cost of 14,957 US dollars per event. These data may be of interest to managed care decision makers when evaluating the cost impact of new therapies or providing more comprehensive anticoagulation management services for existing therapies.

Venous Thromboembolism Risk Assessment, Prophylaxis Practices and Interventions for its Improvement (AVAIL-ME Extension Project, Iran)

The Frequency of Venous Thromboembolism (VTE) Prophylaxis Among Patients Hospitalized for Cancer in the US

Introduction: Recent American Heart Association/American Stroke Association guidelines suggest that physical venous thromboembolism (VTE) prophylaxis modalities are effective at preventing VTE events. Objective: To compare the incidence of VTE events among AIS patients receiving either pharmacologic prophylaxis or physical prophylaxis during hospitalization. Methods: Single center data was retrospectively analyzed among AIS patients who developed DVT or PE during their hospitalization. Patients were selected from January 1, 2016 - December 31, 2020. Inclusion criteria included age 18 and above, AIS patients, diagnosis of acute or chronic VTE events, and exclusive use of physical or pharmacologic VTE prophylaxis modality. We excluded patients who received combined SCD and pharmacologic prophylaxis during hospitalization. Results: Of 5104 patients diagnosed with AIS, 40 patients (0.8%) developed VTE events during their hospitalization. Of these, 29/40 (73%) received pharmacologic VTE prophylaxis and 11/40 (27%) received physical VTE prophylaxis. Of the 3488 patients receiving pharmacologic VTE prophylaxis, 29 (0.8%) developed VTE. Of the 1616 that received physical VTE prophylaxis, 11 (0.7%) developed VTE. Conclusions: Our single center study observed higher rates of VTE events among AIS patients receiving pharmacologic VTE prophylaxis in comparison to physical VTE prophylaxis.

Venous thromboembolism in plastic surgery patients: Survey results of plastic surgeons

Prevention of Venous Thromboembolism in Patients with Multiple Myeloma Receiving Immunomodulatory Therapy: Real-World Examination of the Impede Study

Improving Compliance with Guidelines for Venous Thromboembolism (VTE) Prophylaxis Significantly Reduces VTE Events.

Venous Thromboembolism Events After Hip Arthroscopy: A Systematic Review

Estimated Annual Number of Incident and Recurrent, Non-Fatal and Fatal Venous Thromboembolism (VTE) Events in the US.

Incidence Rate of Venous Thromboembolism (VTE) and Utilization of a VTE Prophylaxis Orderset Module In Hospitalized Patients With Leukemia

A meta-analysis and systematic review of venous thromboembolism prophylaxis in patients undergoing vascular surgery procedures