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Are hospitals delivering appropriate VTE prevention? The venous thromboembolism study to assess the rate of thromboprophylaxis (VTE start).

Amin A, Spyropoulos AC, Dobesh P, Shorr A, Hussein M, Mozaffari E, Benner JS - J. Thromb. Thrombolysis (2010)

Bottom Line: For patients at risk, the recommended type (mechanical or pharmacologic), dose, and duration of thromboprophylaxis was identified based on the guidelines and compared to the regimen actually received, if any.The implementation of ACCP7 guidelines for type, dosage, and duration of thromboprophylaxis is low in patients at risk of VTE.There is a need for physicians and health systems to improve awareness and implementation of recommended thromboprophylaxis.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, University of California Irvine, Irvine, CA, USA. anamin@uci.edu

ABSTRACT
The 7th conference of the American College of Chest Physicians (ACCP7) provides recommendations on the type, dose, and duration of thromboprophylaxis in hospitalized patients at risk of venous thromboembolism (VTE), but the extent to which hospitals follow these criteria has not been well studied. Discharge and billing records for patients admitted to any of 16 acute-care hospitals from January 2005 to December 2006 were obtained. Patients 18 years or older who had an inpatient stay >or=2 days and no apparent contraindications for thromboprophylaxis were grouped into the categories of critical care, surgery and medically ill before being assessed for additional VTE risk factors based on the diagnostic criteria outlined in ACCP7. For patients at risk, the recommended type (mechanical or pharmacologic), dose, and duration of thromboprophylaxis was identified based on the guidelines and compared to the regimen actually received, if any. Among the 258,556 hospitalized patients, 68,278 (26.4%) were determined to be at risk of VTE without apparent contraindications for thromboprophylaxis. The proportions of patients who received the appropriate type, dose, and duration of thromboprophylaxis were 10.5, 9.8, and 17.9% for critical care, medical, and surgical patients, respectively. Of those at risk, 36.8% received no thromboprophylaxis and an additional 50.2% received thromboprophylaxis deemed inappropriate for one or more reasons. The implementation of ACCP7 guidelines for type, dosage, and duration of thromboprophylaxis is low in patients at risk of VTE. There is a need for physicians and health systems to improve awareness and implementation of recommended thromboprophylaxis.

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Construction of study sample
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Fig1: Construction of study sample

Mentions: Of 258,556 patients for whom data were available, 135,954 (53%) met at least one exclusion criterion (Fig. 1). After establishing the main diagnostic groups (critical care, surgical, and medical) and applying the additional risk-factor criteria specified in ACCP7, we identified 68,278 patients at risk of VTE (26.4%). Of these, approximately equal percentages were critical care, surgical, and medical patients. Most patients were female, elderly, and Caucasian with an average LOS of 5.3 days, attended by internists and primary care physicians, and insured by public (mostly Medicare and Medicaid) or commercial health insurance (Table 1).Fig. 1


Are hospitals delivering appropriate VTE prevention? The venous thromboembolism study to assess the rate of thromboprophylaxis (VTE start).

Amin A, Spyropoulos AC, Dobesh P, Shorr A, Hussein M, Mozaffari E, Benner JS - J. Thromb. Thrombolysis (2010)

Construction of study sample
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2837191&req=5

Fig1: Construction of study sample
Mentions: Of 258,556 patients for whom data were available, 135,954 (53%) met at least one exclusion criterion (Fig. 1). After establishing the main diagnostic groups (critical care, surgical, and medical) and applying the additional risk-factor criteria specified in ACCP7, we identified 68,278 patients at risk of VTE (26.4%). Of these, approximately equal percentages were critical care, surgical, and medical patients. Most patients were female, elderly, and Caucasian with an average LOS of 5.3 days, attended by internists and primary care physicians, and insured by public (mostly Medicare and Medicaid) or commercial health insurance (Table 1).Fig. 1

Bottom Line: For patients at risk, the recommended type (mechanical or pharmacologic), dose, and duration of thromboprophylaxis was identified based on the guidelines and compared to the regimen actually received, if any.The implementation of ACCP7 guidelines for type, dosage, and duration of thromboprophylaxis is low in patients at risk of VTE.There is a need for physicians and health systems to improve awareness and implementation of recommended thromboprophylaxis.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, University of California Irvine, Irvine, CA, USA. anamin@uci.edu

ABSTRACT
The 7th conference of the American College of Chest Physicians (ACCP7) provides recommendations on the type, dose, and duration of thromboprophylaxis in hospitalized patients at risk of venous thromboembolism (VTE), but the extent to which hospitals follow these criteria has not been well studied. Discharge and billing records for patients admitted to any of 16 acute-care hospitals from January 2005 to December 2006 were obtained. Patients 18 years or older who had an inpatient stay >or=2 days and no apparent contraindications for thromboprophylaxis were grouped into the categories of critical care, surgery and medically ill before being assessed for additional VTE risk factors based on the diagnostic criteria outlined in ACCP7. For patients at risk, the recommended type (mechanical or pharmacologic), dose, and duration of thromboprophylaxis was identified based on the guidelines and compared to the regimen actually received, if any. Among the 258,556 hospitalized patients, 68,278 (26.4%) were determined to be at risk of VTE without apparent contraindications for thromboprophylaxis. The proportions of patients who received the appropriate type, dose, and duration of thromboprophylaxis were 10.5, 9.8, and 17.9% for critical care, medical, and surgical patients, respectively. Of those at risk, 36.8% received no thromboprophylaxis and an additional 50.2% received thromboprophylaxis deemed inappropriate for one or more reasons. The implementation of ACCP7 guidelines for type, dosage, and duration of thromboprophylaxis is low in patients at risk of VTE. There is a need for physicians and health systems to improve awareness and implementation of recommended thromboprophylaxis.

Show MeSH
Related in: MedlinePlus