Prophylaxis against venous thromboembolism in acutely ill medical patients: an observational study

Carla M Peterman, Daniel M Kolansky, Sarah A Spinler
Pharmacotherapy 2006, 26 (8): 1086-90

STUDY OBJECTIVES: To determine the risk factors for venous thromboembolism (VTE) and the rates of prophylactic measures used in acutely ill medical patients.

DESIGN: Prospective observational study.

SETTING: Academic tertiary care medical center.

PATIENTS: One hundred seventy-nine patients admitted to three general medical units over 30 consecutive days and hospitalized for at least 3 days.

MEASUREMENTS AND MAIN RESULTS: On concurrent review of the patients' medical records, 138 (77.1%) of 179 patients received one or more forms of VTE prophylaxis during their hospital stay. Of 41 (22.9%) patients receiving no VTE prophylaxis, 22 (53.7%) had and 19 (46.3%, or 10.6% of the total population) did not have a documented contraindication to anticoagulation. One hundred ten patients (61.5%) had three or more documented VTE risk factors for VTE. The most common prophylaxis was unfractionated heparin 5000 U injected subcutaneously twice/day. Therapeutic anticoagulation was given to 51 patients (28.5%) at some time during their hospitalization for indications other than VTE treatment. Two developed symptomatic VTE (1.1%) while hospitalized. Four patients (2.2%) receiving anticoagulants had adverse outcomes. One patient had minor bleeding, and one developed heparin-induced thrombocytopenia without thrombosis.

CONCLUSION: Rates of VTE prophylaxis were higher than previously reported rates, although no formalized guidelines, standardized order sets, alerting programs, training, or risk-stratification tools were used during the study period. Rates of adverse events were low.

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