Inpatient and outpatient occurrence of deep vein thrombosis and pulmonary embolism and thromboprophylaxis following selected at-risk surgeries

Alpesh N Amin, Jay Lin, Stephen Thompson, Daniel Wiederkehr
Annals of Pharmacotherapy 2011, 45 (9): 1045-52

BACKGROUND: Despite evidence-based guidelines on prevention, many surgical patients remain at risk of deep vein thrombosis (DVT) and pulmonary embolism (PE).

OBJECTIVE: To quantify the provision of thromboprophylaxis and proportion of US surgical patients who develop DVT/PE, both in the hospital and postdischarge.

METHODS: This study was an observational, retrospective database analysis of national managed care data. Data were extracted from the Premier Perspective-i3 Pharma Informatics linked database on patients hospitalized between January 2005 and November 2007 for orthopedic surgery or major abdominal surgery. Patients were included if they were aged 18 years or older at the time of hospitalization and had at least 6 months of continuous plan enrollment prior to index hospitalization. Patients discharged to an acute care facility or with atrial fibrillation were excluded. Prophylaxis status was evaluated during index hospitalization and for 14 days postdischarge. The proportion of patients who developed DVT/PE was calculated during index hospitalization and for 30 days postdischarge.

RESULTS: The analysis included 19,581 patients following major abdominal surgery and 5315 patients following orthopedic surgery. Inpatient pharmacologic or mechanical thromboprophylaxis was received by 58.7% of abdominal surgery patients and 85.0% of orthopedic surgery patients; outpatient pharmacologic prophylaxis was received by 1.6% and 58.4% of patients, respectively. Total mean (SD) prophylaxis duration was 1.7 (3.7) days following abdominal surgery and 13.0 (11.6) days following orthopedic surgery. The proportion of abdominal surgery patients who developed symptomatic DVT/PE was 1.6%; 3.1% of orthopedic surgery patients developed symptomatic DVT/PE, with almost 40% of the events occurring postdischarge.

CONCLUSIONS: Continued efforts are needed to prevent DVT/PE after abdominal and orthopedic surgery. Initiatives that encourage outpatient prophylaxis must ensure that appropriate prophylaxis of adequate duration is prescribed to all at-risk surgical patients to further reduce DVT/PE across the continuum of care. Pharmacists can play an important role in optimizing continuity of patient care in the prevention of DVT, in providing anticoagulation services that can help reduce the incidence of DVT/PE and bleeding complications, and in helping hospitals achieve performance measures.

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