Awareness Of Venous Thromboembolism Research Articles

ExPeKT—Exploring prevention and knowledge of venous thromboembolism: a two-stage, mixed-method study protocol

IntroductionThere is little awareness of venous thromboembolism (VTE) in the public arena. Most commonly known causes are—travellers’ thrombosis and thrombosis associated with oral contraception, both frequently referred to in the...

Knowledge of thromboprophylaxis guidelines pre- and post-didactic lectures during a venous thromboembolism awareness day at a tertiary-care hospital

BACKGROUND:Didactic lectures are frequently used to improve compliance with practice guidelines. This study assessed the knowledge of health-care providers (HCPs) at a tertiary-care hospital of its evidence-based thromboprophylaxis guidelines and the impact of didactic lectures on their knowledge.METHODS:The hospital launched a multifaceted approach to improve thromboprophylaxis practices, which included posters, a pocket-size guidelines summary and didactic lectures during the annual thromboprophylaxis awareness days. A self-administered questionnaire was distributed to HCPs before and after lectures on thromboprophylaxis guidelines (June 2010). The questionnaire, formulated and validated by two physicians, two nurses and a clinical pharmacist, covered various subjects such as risk stratification, anticoagulant dosing and the choice of anticoagulants in specific clinical situations.RESULTS:Seventy-two and 63 HCPs submitted the pre- and post-test, respectively (62% physicians, 28% nurses, from different clinical disciplines). The mean scores were 7.8 ± 2.1 (median = 8.0, range = 2-12, maximum possible score = 15) for the pre-test and 8.4 ± 1.8 for the post-test, P = 0.053. There was no significant difference in the pre-test scores of nurses and physicians (7.9 ± 1.7 and 8.2 ± 2.4, respectively, P = 0.67). For the 35 HCPs who completed the pre- and post-tests, their scores were 7.7 ± 1.7 and 8.8 ± 1.6, respectively, P = 0.003. Knowledge of appropriate anticoagulant administration in specific clinical situations was frequently inadequate, with approximately two-thirds of participants failing to adjust low-molecular-weight heparin doses in patients with renal failure.CONCLUSIONS:Education via didactic lectures resulted in a modest improvement of HCPs′ knowledge of thromboprophylaxis guidelines. This supports the need for a multifaceted approach to improve the awareness and implementation of thromboprophylaxis guidelines.

Improving VTE prophylaxis in hospitalized oncologic patients: Institutional impact VTE mentored QI project.

148 Background: Venous thromboembolism (VTE), which includes deep vein thrombosis and pulmonary embolism affects hundreds of thousand Americans each year. Pulmonary embolism(PE), is the 3rd leading cause of hospital related death and the most common preventable cause of death in the United States. Cancer is associated with 6-fold increase in the risk of VTE. For those undergoing surgery, the risks of post-operative DVT and fatal PE are 2-3 times greater, respectively, for cancer patients than non-cancer patients. VTE prophylaxis is widely available and effective, but frequently underused. VTE prevention is of particular concern to oncologists. Evidence based oncology-specific guidelines are available from several organizations including American Society of Clinical Oncology (ASCO) to highlight the importance of prophylaxis in oncology patients. An Interdisciplinary team of pharmacists and hospitalists received an educational grant to implement a VTE mentored project in a large Comprehensive Academic Cancer Center in the Southern United States. There was anecdotal evidence and data to suggest adherence to thrombo-prophylaxis was suboptimal, with multiple departments and physicians having their "own" order sets of varying complexities. Performance data on VTE was not routinely being collected and data on hospital-acquired VTE events was not consistently collected and reported. To meet increasing financial, regulatory and the clinical challenge of harmonizing VTE prophylaxis in the institution, a multi-disciplinary team was formed to implement this VTE initiative. Methods: The QI methodology used was the Plan, Do, Study and Act (PDSA). Step 1. Draft a single VTE protocol using best evidence with input from all stakeholders that will be acceptable to most users. Step 2. Analyze the care delivery throughout the hospital Step 3. Set up performance tracking with IT support Step 4. Staggered introduction/education of the VTE protocol across departments/physicians Step 5. Implement and track through cycles of PDSA. Results: The institution went from having about 10 different VTE order sets to a single VTE order set that was a single page and was utilized by medical, surgical and emergency room and ICU physicians. This was embed in all admission, transfer and post op orders. Use of VTE prophylaxis order set went from an aggregate of 40.7 to 76.1%, 3 months after implementation of initiative. 26% percent of patient with no prophylaxis ordered had no contraindications checked. 60.9% and 16% of admitted patients were risk stratified as moderate or high risk respectively. Conclusions: 4 key findings from the implementation project led to improved rates of thrombo-prophylaxis. Prescribers are in the best position to understand all components of the VTE risk as well as contraindications and should be responsible for VTE risk assessment, as hitherto nurses were doing risk assessment and physicians were prescribing prophylaxis. New VTE order set provided a linked menu of appropriate prophylaxis options for each level of risk which the older sets did not do. Embedding VTE order set in admission/transfer and post op orders sets led to increase use. Efforts to raise VTE awareness should be ongoing, routinely monitored and included with other safety indicators such as falls etc and reported back to providers and appropriate medical staff and executive committees.

Trends in Venous Thromboembolism-Related Hospitalizations, 1994–2009

Information on trends in venous thromboembolism (VTE) in US children is scant and inconsistent. We assessed national trends in VTE-associated pediatric hospitalizations. All nonroutine newborn hospitalizations for children 0 to 17 years of age in the 1994-2009 Nationwide Inpatient Samples were included; routine newborn discharges were excluded. VTE diagnoses were identified by using the International Classification of Diseases, Ninth Revision, Clinical Modification codes. Variance weighted least square regression was used to assess trends in patient characteristics and rates of hospitalization per 100000 population <18 years of age. Multivariable logistic regression models were used to estimate the probability of VTE diagnosis over the study period. The rate of VTE-associated hospitalization increased for all age subgroups (<1, 1-5, 6-11, and 12-17 years), with the largest increase noted among children <1 year of age (from 18.1 per 100000 during 1994 to 49.6 per 100000 during 2009). Compared with 1994-1997, the adjusted odds of hospitalization with a VTE diagnosis were 88% higher during 2006-2009 (adjusted odds ratio: 1.88 [95% confidence interval: 1.64-2.17]). Venous catheter use, mechanical ventilation, malignancy, hospitalization ≥ 5 days, and VTE-related medical conditions were associated with increased likelihood of VTE diagnosis. The rate of VTE-associated hospitalization among US children increased from 1994 through 2009. Increases in venous catheter procedures were associated with and may have contributed to the observed trends. The degree to which increased awareness of VTE influenced the temporal differences could not be determined.

Educating Surgical Patients to Reduce the Risk of Venous Thromboembolism: An Audit of an Effective Strategy

ObjectivesVenous thromboembolism (VTE) causes approximately 25,000 deaths each year from hospital-acquired thrombosis in the UK. Patient understanding of risk factors and preventive measures is important in preventing VTE. This audit was designed to assess surgical patient awareness and understanding of VTE risk factors and prophylaxis.DesignA questionnaire was designed to assess preoperative patient understanding of components of the National Institute for Health and Clinical Excellence (NICE) guidelines. Leaflets were designed to address gaps in understanding and junior doctors were given guidance on patient education. A second group of patients completed the same questionnaire after introduction of the education system.SettingWorthing Hospital, UK.ParticipantsOne hundred and twenty-one patients due to undergo major general surgery. Seventy-one participants completed the questionnaire prior to implementation of the education system, and 50 after.Main outcome measuresImprovement in patient awareness of VTE, its risk factors and its preventative measures (in response to the education system).ResultsFollowing the introduction of a targeted VTE education system, there was a significant improvement in the awareness of VTE to 90% (P < 0.01), its signs to 80% (P < 0.01), and its preventative measures to 84% (P < 0.01).ConclusionsPatient education is of paramount importance in reducing the risks of VTE perioperatively. A simple method of introducing patient education at pre-assessment clinic and as part of their discharge planning, for major elective surgery, is an effective system in improving patient understanding of VTE, its risk factors and the importance of prophylaxis. It may also increase compliance.

Prevalence of clinical venous thromboembolism in the USA: Current trends and future projections

The U.S.-wide prevalence of venous thromboembolism (VTE) is unclear, with reported VTE incidence estimates varying widely. This retrospective analysis of healthcare claims data from patients in the Thomson Reuters national MarketScan(®) Commercial and Medicare databases (January 2002-December 2006) estimates the U.S. prevalence of VTE, and assesses associated temporal trends. Of 12.7 million study-eligible patients, 200,007 had VTE. The overall prevalence of VTE (cases per 100,000) increased by 33.1% during the study period: from 317 in 2002 to 422 in 2006. VTE was more prevalent in women than men throughout the study. The annual prevalence of VTE increased with age: 1,382 in patients ≥65 years versus 231 in patients <65 (2006 data). The number of U.S. adults with VTE is projected to more than double from 0.95 million in 2006 to 1.82 million in 2050. These data confirm that VTE remains a major healthcare burden in the US, particularly among the elderly, and highlight a continuing increase in prevalence of the disease. Greater efforts are required to improve awareness of VTE and improve standards of VTE prevention in healthcare organizations.

Venous thromboembolism in the US: does race matter?

Studies investigating racial differences in the prevalence of venous thromboembolism (VTE) have generally been conducted on a limited scale. This analysis measured VTE prevalence across racial groups in a population of US Medicaid enrollees from 2002 to 2005. Records for patients aged ≥ 18 years with VTE between January 1, 2002 and December 31, 2005 were retrieved from the MarketScan® Multi-State Medicaid Database from Thomson Reuters. Patients were classified as having VTE in each calendar year by the presence of a VTE diagnosis on an inpatient claim or ≥ 1 outpatient claim with VTE diagnosis plus evidence of anticoagulant use. Patients dually eligible for Medicaid and Medicare were excluded. Logistic regression was used to calculate the odds of VTE. An average of 4.5 million Medicaid enrollees were study eligible in each calendar year, 72.2% of which had deep-vein thrombosis, 22.5% pulmonary embolism, and 5.3% had both. Patients were mainly Caucasian (46.8%), African-American (26.0%), and Hispanic (14.1%). VTE prevalence per 100,000 enrollees was highest in African-American males (584 in 2002-784 in 2005), followed by Caucasian males (457-643), Caucasian females (335-446), and African-American females (348-444). Hispanic males (94-149) and females (93-154) had lower prevalence of VTE. African-Americans had a significantly higher probability of having a VTE event than Caucasians (adjusted odds ratio 1.04, 95% confidence interval 1.00-1.07, P = 0.036). VTE prevalence increased over the study period and was highest in African-American males. More coordinated efforts are required to improve VTE awareness and prevention across all racial and ethnic groups.

Patient (PT) understanding of venous thromboembolism (VTE) risks associated with lenalidomide (Len) and thalidomide (Thal), previous clots, and current prophylaxis.

e16512 Background: PTs takingLen and Thal alone or in combination with high dose dexamethasone are at risk for deep venous thrombosis (DVT) and pulmonary embolism (PE). PT and provider awareness of VTE and optimal means of prevention is relatively unknown. This ongoing cross-sectional survey assessed the following objectives: 1) PT understanding of VTE risk associated with Len and Thal, 2) previous history of VTE among these PTs, and 3) current prophylaxis. Methods: A novel collaboration was developed between the specialty service demonstration outpatient pharmacy site (Walgreens Pharmacy) at Northwestern, and the Research on Adverse Drug Events and Reports (RADAR) team. A survey was developed and administered to PTs who filled a prescription for Len or Thal between July 2009 and December 2009. This pharmacy is the primary on-site location for outpatient prescriptions associated with the NCI-designated Robert H. Lurie Comprehensive Cancer Center at Northwestern. Results: A total of 23 PTs met eligibility requirements; 74% consented (14 = Len, 3 = Thal). Indications included: multiple myeloma (12), myelodysplastic syndrome (3), plasma cell lymphoma (1) and unspecified (1). Mean age= 64 (95% CI 59-70), 71% male. The proportion indicating awareness of increased clot risk while on Len or Thal was 82% (57%-96%). However, only 47% reported physician recommendation of prophylaxis and only 3 were on low molecular weight heparin or warfarin. The majority of PTs with prophylaxis were on aspirin alone (5/8). Three PTs reported history of clots (DVT = 1, PE = 1, PE and DVT = 1); all of these reported no current prophylaxis. Conclusions: In this patient subset, there is a significant discordance between PT-physician awareness of VTE risk and VTE prophylaxis. Althoughthemajority of PTs were aware of increased clot risk, less than half reported physician recommendation of prophylaxis. Further work to identify new thrombosis incidence and optimal means of prophylaxis is needed. If prophylaxis options prove to be effective, both patient education and provider awareness stand as areas of potential improvement. No significant financial relationships to disclose.

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

Background: Venous thromboembolism (VTE) is reported in about five percent of patients with malignancy and is often associated with serious clinical outcomes such as major infarction, hemorrhage and death. The prevalence rates of malignancy-related VTE is most likely underestimated, in part because of the frequent presence of confounding risk factors, such as advanced age, prolonged immobilization, surgical procedures, and chemotherapeutic regimens. Occurrence of VTE can increase the likelihood of death for cancer patients by 2- to 8-fold. Prophylactic anticoagulation therapy and mechanical prophylaxis is recommended for all inpatients with a diagnosis of active malignancy. Mechanical prophylaxis alone is recommended for patients if contraindication to anticoagulation therapy exists. Roswell Park Cancer Institute (RPCI), a Comprehensive Cancer Center with 24,000 active patients under its care, initiated an Institute-Wide Quality Improvement Initiative in 2006 to improve the rates of VTE prophylaxis for all adult inpatient admissions. The objectives were to improve compliance with national guidelines on VTE prophylaxis and to reduce future VTE events in our patient population.Methods: VTE prophylaxis based on National Comprehensive Cancer Network (NCCN) guidelines was instituted on all Medical services. Surgical services followed guidelines in accordance with NCCN and Surgical Best Practice and published standards. Mandatory physician order entry forms including computerized physician order entry were implemented. VTE awareness and staff education was promoted via informational materials, field in-services and seminars. In order to track compliance, manual audits of patient charts were performed every 3 months.Results: Results: Initial surveys revealed 61% compliance with guidelines on the medicine service and 86% on the surgical services. Overall institute-wide VTE Prophylaxis compliance improved from 80% to 95% following implementation of the initiative (shown in table 1). This has resulted in a decrease in VTE incidence from 0.39% in the last quarter of 2006 when the initiative was launched to 0.13% and 0.08% seen in the first and second quarters of 2008 respectively (P<0.0001). The actual events dropped from 40 in the last quarter of 2006 to 14 events and 10 events in the first and the second quarter of 2008 respectively. The greatest benefit was seen in reduction in outpatient VTE and on the medical services.Conclusions: Implementation of our VTE Prophylaxis Initiative resulted in improved compliance with national guidelines at RPCI and has resulted in a highly significant and clinically relevant reduction of VTE in our vulnerable patient population.Table 1: Institute Compliance rate on VTE prophylaxis200620072008ComplianceQ4Q1Q2Q3Q4Q1Q2Medical Services61%78%86%95%96%90%90%Surgical Service86%92%98%98%97%97%100%Institute-Wide80.40%86.80%93.60%96.60%96.50%94.60%95.4%Table 2: VTE events200620072008Q1Q2Q3Q4Q1Q2Q3Q4Q1Q2# VTE/Quarter31304040382934171410# Admission/Outpatients10439115181036710298102301107210815118521088713234%0.30%0.26%0.39%0.39%0.37%0.26%0.31%0.14%0.13%0.08%

Awareness and Politics of Venous Thromboembolism in the United Kingdom

Because of travelers’ thrombosis, hard campaigning, and lobbying, the awareness of venous thromboembolism is markedly improving within the United Kingdom. The present improvements relate directly to championing of the cause by a charity and British politicians. This article summarizes the story of the awakening, which had occurred since 2000. “Education, education, education.” Tony Blair, British Prime Minister, 1997 to 2007. In September 2000 the death of a 28-year-old woman, Emma Kristofferson, who collapsed and died from a pulmonary embolism after leaving a 20-hour flight from Sydney to Heathrow airport provoked a media furor. Since that time there have been numerous articles in the British press about travel & deep vein thrombosis (DVT), such that the average informed member of the public is aware of the initials DVT but relates risk to travel. The words “economy class syndrome” and “travelers thrombosis” have entered common parlance. A Lifeblood commissioned MORI poll of more than 2000 people in the UK in 2006 showed that more than 50% of the population could associate leg pain and swelling with the word thrombosis. The issue of travelers’ thrombosis was also picked up by the House of Commons Science and Technology Committee in their report on Air Travel and Health in 2001,1 and after hearing evidence from experts they demanded the airlines provided more information. John Smith MP, Labor member for the Vale of Glamorgan, was elected chairman of an all-party group set up to investigate the causes of flight-related deep vein thrombosis (DVT) and campaigned to increase awareness.2 Despite the growing recognition since 2000 that the risks of developing travelers’ thrombosis are very low for the healthy traveling public, the press interest in this has been sustained. In 2002 frustrated with the lack of awareness and understanding among health professionals and the general public …

An Evaluation of Venous Thromboembolic Risk in Acutely Ill Medical Patients Immobilized at Home: The AT-HOME Study

Many risk factors for venous thromboembolism (VTE) in hospitalized medical patients are also present in medical outpatients. VTE prevention represents an important challenge for physicians treating patients at home. The AT-HOME study was a prospective cross-sectional observational study designed to assess awareness of the risk of VTE in immobilized acutely ill medical outpatients among German physicians, many of whom were participating in a national Continuing Medical Education (CME) program designed to raise awareness of VTE. The study involved 1210 medical patients who were acutely confined to bed at home. Physicians performed a subjective assessment of VTE risk, which was rated on a 10-point scale (1 = very low risk; 10 = very high risk). The risk of VTE was also assessed retrospectively by using a scorecard developed for use in hospitalized medical patients. Of the 1210 patients, 198 (16%) had risk scores of 0-4, 319 (26%) had scores of 5 or 6, and 693 (57%) had scores > or =7. Overall, 966 patients (80%) received thromboprophylaxis. The proportion of patients receiving thromboprophylaxis was 0% to 47% in risk score groups 0-4, 76% to 85% in groups 5 and 6, and 90% to 100% in risk score groups 7-10. In the retrospective assessment of VTE risk, 74% of patients were at high risk, 15% were at intermediate risk, and 11% were at low risk. The proportions of patients receiving thromboprophylaxis in these groups were 87%, 61%, and 55%, respectively. The involvement of physicians in educational activities focusing on VTE awareness appeared to create awareness of the risks of VTE in acutely ill medical outpatients.

Venous thromboembolism prophylaxis in medically ill patients and the development of strategies to improve prophylaxis rates

Venous thromboembolism (VTE) is common but often unrecognized in medically ill patients. Over the past 5 years, three large-scale placebo-controlled trials enrolling a total of 5500 medically ill patients have highlighted the risk of VTE in this group. These trials have helped to define a specific at-risk patient profile, including those admitted to the hospital with severe congestive heart failure, respiratory illness, acute infection, and inflammatory bowel disease. We performed a retrospective review of patients admitted to the medical service at our tertiary care center to define how common the at-risk medical patient is and to evaluate and improve prophylaxis rates in this patient group. The study was conducted in two phases. Based on admission characteristics, patients were stratified into high-risk or low-risk groups for the development of VTE. During the pre-intervention phase, 75% of patients admitted to the medical service were characterized as increased risk for VTE, yet only 43% of these high-risk patients received prophylaxis of any sort. After interventions designed to increase awareness of VTE, we conducted a second review period. In this post-intervention phase, where 79% of patients were at risk for VTE, prophylaxis rates improved to 72%. Based on these results, we conclude that the majority of patients admitted to the medical service at our tertiary care center constitute a high-risk population that warrants consideration for VTE prophylaxis. Implementation of strategies to improve prophylaxis rates, including educational sessions and risk stratification guidelines, can be successful and improve identification and prophylaxis of this population.