Venous Thromboembolism Prophylaxis Over & Underutilized in Some Hospitalized Patients

MedicalResearch.com Interview with:
Paul Grant, MD

Associate Professor of Medicine Associate Chief Medical Information Officer Director, Perioperative and Consultative Medicine Division of Hospital Medicine Department of Internal Medicine Michigan Medicine University of Michigan

Dr. Grant

Associate Professor of Medicine
Associate Chief Medical Information Officer
Director, Perioperative and Consultative Medicine
Division of Hospital Medicine
Department of Internal Medicine
Michigan Medicine
University of Michigan

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: It is well known that hospitalized medical patients are at risk for venous thromboembolism VTE, but the severity of patient risk can vary significantly. National guidelines have consistently stated that low-risk patients should not receive VTE prophylaxis beyond early ambulation.

In this retrospective cohort study, we analyzed data from 52 hospitals participating in the Michigan Hospital Medicine Safety consortium. Trained medical record abstractors at each hospital collected data from 44,775 medical patients including VTE risk factors, type of VTE prophylaxis administered, and contraindications to pharmacologic prophylaxis. Individual patient risk of VTE was determined using the Padua risk assessment model.

Of the 32,549 low-risk patients, 77.9% received excess venous thromboembolism prophylaxis as either pharmacologic prophylaxis (30.6%), mechanical prophylaxis (20.8%), or both (26.5%). In the 12,226 high-risk patients, VTE prophylaxis was underused in 22% of patients. The rates of inappropriate prophylaxis varied considerably by hospital. 

MedicalResearch.com: What should readers take away from your report?

Response: For years, strong emphasis has been placed on venous thromboembolism prophylaxis for hospitalized patients. And while this is good practice for high-risk patients, it seems an unintended consequence has been excessive prophylaxis in low-risk patients. Drawbacks of excessive VTE prophylaxis includes bleeding, patient discomfort, medication cost, and the risk for heparin-induced thrombocytopenia. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

Response: Developing strategies to scale back excess  venous thromboembolism prophylaxis in low-risk patients are needed.

MedicalResearch.com: Is there anything else you would like to add?

Response: This study was supported through funding from Blue Cross Blue Shield of Michigan.

Citation:

Grant PJ, Conlon A, Chopra V, Flanders SA. Use of Venous Thromboembolism Prophylaxis in Hospitalized Patients. JAMA Intern Med. Published online May 21, 2018. doi:10.1001/jamainternmed.2018.2022 

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