New onset of venous thromboembolism among hospitalized patients at Brigham and Women's Hospital is caused more often by prophylaxis failure than by withholding treatment.
BACKGROUND
Guidelines to prevent venous thromboembolism (VTE) have been widely distributed and generally have been assumed to be effective. Therefore, among hospitalized patients, the development of VTE is thought to occur in the context of omitted prophylaxis.


OBJECTIVE
To describe hospitalized patients who develop VTE and to determine whether they received antecedent prophylaxis.


METHODS
Case series.


METHODS
Brigham and Women's Hospital.


METHODS
Three hundred eighty-four patients who developed in-hospital deep venous thrombosis or pulmonary embolism or who developed VTE within 30 days of prior hospital discharge.


METHODS
The relationship of developing new-onset VTE to the use or omission of antecedent in-hospital prophylaxis.


RESULTS
Of the 384 identified patients, 272 had deep venous thrombosis alone, 62 had pulmonary embolism alone, and 50 had deep venous thrombosis and pulmonary embolism. Most were medical service patients; fewer than one fourth were general or orthopedic surgery patients. Overall, 52% had received antecedent VTE prophylaxis. Thirteen deaths (3.4%) were ascribed to pulmonary embolism, and prophylaxis was omitted in only 1 of those 13 patients.


CONCLUSIONS
Most deaths from pulmonary embolism among patients hospitalized for other conditions occurred in the setting of failed prophylaxis rather than omitted prophylaxis. High-risk patients, especially medical service patients, warrant intensive VTE prophylaxis and close follow-up to ensure successful outcomes.
Goldhaber
S Z
SZ
Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA. sgoldhaber@partners.org
Dunn
K
K
MacDougall
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RC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D012307:Risk Factors; D020246:Venous Thrombosis / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*
D000925:Anticoagulants