Venous thromboembolic prophylaxis in hospitalized medical patients

BACKGROUND: The risk for venous thromboembolism (VTE) in medical patients is similar to that in moderate-risk surgery patients. Pharmacologic thromboprophylaxis is recommended for certain medical patients, but its use in clinical practice is unknown. OBJECTIVE: To assess whether medically ill patients with established risk factors receive pharmacologic VTE prophylaxis and determine whether prescribed regimens are consistent with current evidence and published recommendations. METHODS: A retrospective chart review of 100 patients admitted to a hospital medicine service was conducted. Patients who were >40 years of age and admitted for congestive heart failure, chronic obstructive pulmonary disease, or respiratory infection were considered appropriate candidates for VTE prophylaxis if they had no documented bleeding risk factors. Patients considered at increased risk of bleeding included those with documented uncontrolled hypertension, thrombocytopenia, coagulopathy, or recent gastrointestinal bleeding. Prescribed regimens were evaluated to determine whether they were consistent with regimens proven in clinical trials to be effective and safe. RESULTS: Thirty-one percent of the patients with established VTE risk factors and no documented risk factors for bleeding were prescribed pharmacologic VTE prophylaxis. An established regimen was prescribed in only 19% of those receiving prophylaxis. CONCLUSIONS: There is significant underutilization of VTE prophylaxis in this patient population. Patients are not adequately assessed for bleeding risk factors, and a portion of prescribed regimens are not those that have been established in the literature. Expert consensus statements recommend that hospitals develop strategies to prevent VTE events in their patients. Strategies to improve patient screening and physicians' prescribing habits are needed.