Real-World Rates of In-hospital and Postdischarge Deep-Vein Thrombosis and Pulmonary Embolism in At-Risk Medical Patients in the United States (original) (raw)
Related papers
Assessment of venous thromboembolism risk and the benefits of thromboprophylaxis in medical patients
Thrombosis and haemostasis, 2005
Hospitalized patients with acute medical conditions are at significant risk of venous thromboembolism (VTE): approximately 10-30% of general medical patients may develop deep-vein thrombosis or pulmonary embolism, and the latter is a leading contributor to deaths in hospital. Despite consensus-group recommendations that at-risk medical patients should receive thromboprophylaxis, there is currently no consensus as to which patients are at risk, and many patients may not receive appropriate thromboprophylaxis. This paper reviews evidence for the risk of VTE associated with different medical conditions and risk factors, and presents a risk-assessment model for risk stratification in medical patients. Medical conditions associated with a moderate to high risk of VTE include cardiac disease, cancer, respiratory disease, inflammatory bowel disease, and infectious diseases. Importantly, analyses of data from the MEDENOX study show that thromboprophylaxis significantly reduces the risk of V...
Pharmaco-prophylaxis of deep vein thrombosis for in-patients at risk, in a tertiary care hospital
International Journal of Basic & Clinical Pharmacology, 2017
Individuals with venous thrombosis constitute 0.64% of all hospital admissions, and two-thirds have Deep Vein Thrombosis (DVT) as their primary manifestation, while the remaining one-third has Pulmonary Embolism (PE). 1,2 Among surgical patients, prevalence of DVT ranges from 15-40% among patients undergoing major general surgical procedures. 3 In Asian patients, incidence of DVT varies from 1.3% in spinal surgery to 41.7% following colorectal surgery. A systematic review and meta-analysis in Asian patients included 22 studies (total population 2454) published from 1979 to 2009 and suggested a possible trend toward increasing incidence of proximal DVT. 4 Among those hospitalized for medical causes, 50%-75% of VTE events, including fatal PE, occurred among hospitalized patients, as reported by a population based case control study. 5 To help stratify the risk for VTE in hospitalized patients, several risk assessment models (RAMs) are employed. 6
JAMA internal medicine, 2014
IMPORTANCE Hospitalization for acute medical illness is associated with increased risk of venous thromboembolism (VTE). Although efforts designed to increase use of pharmacologic VTE prophylaxis are intended to reduce hospital-associated VTE, whether higher rates of prophylaxis reduce VTE in medical patients is unknown. OBJECTIVE To examine the association between pharmacologic VTE prophylaxis rates and hospital-associated VTE. DESIGN, SETTING, AND PARTICIPANTS Retrospective, multicenter cohort study conducted at 35 Michigan hospitals participating in a statewide quality collaborative from January 1, 2011, through September 13, 2012. Trained medical record abstractors at each hospital collected data from 31 260 general medical patients. Use of VTE prophylaxis on admission, VTE risk factors, and VTE events 90 days after hospital admission were recorded using a combination of medical record review and telephone follow-up. Hospitals were grouped into tertiles of performance based on rate of pharmacologic prophylaxis use on admission for at-risk patients.
JAMA Internal Medicine, 2014
IMPORTANCE Hospitalization for acute medical illness is associated with increased risk of venous thromboembolism (VTE). Although efforts designed to increase use of pharmacologic VTE prophylaxis are intended to reduce hospital-associated VTE, whether higher rates of prophylaxis reduce VTE in medical patients is unknown. OBJECTIVE To examine the association between pharmacologic VTE prophylaxis rates and hospital-associated VTE. DESIGN, SETTING, AND PARTICIPANTS Retrospective, multicenter cohort study conducted at 35 Michigan hospitals participating in a statewide quality collaborative from January 1, 2011, through September 13, 2012. Trained medical record abstractors at each hospital collected data from 31 260 general medical patients. Use of VTE prophylaxis on admission, VTE risk factors, and VTE events 90 days after hospital admission were recorded using a combination of medical record review and telephone follow-up. Hospitals were grouped into tertiles of performance based on rate of pharmacologic prophylaxis use on admission for at-risk patients.
Thromboprophylaxis rates in US medical centers: success or failure?
Journal of Thrombosis and Haemostasis, 2007
Background: As hospitalized medical patients may be at risk of venous thromboembolism (VTE), evidence-based guidelines are available to help physicians assess patientsÕ risk for VTE, and to recommend prophylaxis options. The rate of appropriate thromboprophylaxis use in at-risk medical inpatients was assessed in accordance with the 6th American College of Chest Physicians (ACCP) guidelines. Methods: Hospital discharge information from the Premier Perspective TM inpatient data base from January 2002 to September 2005 was used. Included patients were 40 years old or more, with a length of hospital stay of 6 days or more, and had no contraindications for anticoagulation. The appropriateness of VTE thromboprophylaxis was determined in seven groups with acute medical conditions by comparing the daily thromboprophylaxis usage, including type of thromboprophylaxis, dosage of anticoagulant and duration of thromboprophylaxis, with the ACCP recommendations. Results: A total of 196 104 discharges from 227 hospitals met the inclusion criteria. The overall VTE thromboprophylaxis rate was 61.8%, although the appropriate thromboprophylaxis rate was only 33.9%. Of the 66.1% discharged patients who did not receive appropriate thromboprophylaxis, 38.4% received no prophylaxis, 4.7% received mechanical prophylaxis only, 6.3% received an inappropriate dosage, and 16.7% received an inappropriate prophylaxis duration based on ACCP recommendations. Conclusions: This study highlights the low rates of appropriate thromboprophylaxis in US acutecare hospitals, with two-thirds of discharged patients not receiving prophylaxis in accordance with the 6th ACCP guidelines. More effort is required to improve the use of appropriate thromboprophylaxis in accordance with the ACCP recommendations.
Impact of Thromboprophylaxis across the US Acute Care Setting
PloS one, 2015
The risk of venous thromboembolism (VTE) can be reduced by appropriate use of anticoagulant prophylaxis. VTE prophylaxis does, however, remain substantially underused, particularly among acutely ill medical inpatients. We sought to evaluate the clinical and economic impact of increasing use of American College of Chest Physicians (ACCP)-recommended VTE prophylaxis among medical inpatients from a US healthcare system perspective. In this retrospective database cost-effectiveness evaluation, a decision-tree model was developed to estimate deaths within 30 days of admission and outcomes attributable to VTE that might have been averted by use of low-molecular-weight heparin (LMWH) or unfractionated heparin (UFH). Incremental cost-effectiveness ratio was calculated using "no prophylaxis" as the comparator. Data from the ENDORSE US medical inpatients and the US nationwide Inpatient Sample (NIS) were used to estimate the annual number of eligible inpatients who failed to receive ...
European Journal of Internal Medicine, 2012
Venous thromboembolism (VTE) is frequent in patients hospitalized in Internal Medicine wards. It carries a considerable morbidity and mortality. Recommendations for use of anticoagulation are graded 1A in leading evidence-based consensus guidelines. Implementation of these guidelines is suboptimal. Lack of awareness seems to be an important factor for the low implementation rate of thromboprophylaxis in Internal Medicine wards, but other factors may be equally important: some clinicians find the data favoring thromboprophylaxis unconvincing or believe that pharmacological prevention is too risky for the average medical inpatient. The following review will show that although there is a dispute about the clinical importance of some manifestations of thromboembolic disease, anticoagulation significantly reduces the risk for clinically relevant VTE. The bleeding risk in most patients is low and does not outweigh the benefit of treatment. Pharmacological or mechanical thromboprophylaxis is cost-effective when administered to at-risk patients. Better awareness and judicious use of risk assessment models should help the attending physician to balance the risk of VTE against the potential bleeding risk.
Prevention of Venous Thromboembolism in Hospitalized Medical Patients
Cancer Investigation, 2009
ABSTRACT Venous thromboembolism (VTE) is a clinical disease entity which is manifested as deep venous thrombosis and/or pulmonary embolism. VTE presenting as pulmonary embolism (PE) is one of the leading causes of mortality and morbidity in the United States. Pulmonary embolism accounts for 5–10% of deaths in hospitalized patients, making VTE the most common preventable cause of in-hospital death. It appears that PE is more common in hospitalized medical patients than surgical patients, although medical patients are less likely to receive VTE prophylaxis. Up to 15% of hospitalized medical patients who do not receive thromboprophylaxis will develop symptomatic VTE. Fatal PE also seems to occur more frequently in medical rather than surgical patients. The economic burden of VTE is substantial. In 2004, the cost of a VTE occurring in hospital added over $18,000 USD to the median cost of an individual hospitalization and increased the length of stay by a median of almost 10 days. The costs associated with long-term management and chronic complications of VTE that arise after discharge from hospital are also significant. VTE prophylaxis is underused or applied incorrectly in medically ill hospitalized patients. This trend is certain to improve as external regulatory forces monitor physician practices and clinical outcomes. This review summarizes the large body of data on VTE risk factors, the efficacy and safety of pharmacologic and mechanical prophylaxis, and consensus guideline recommendations for primary in-hospital prophylaxis of medical patients.