Prophylaxis against venous thromboembolism in acutely ill medical patients: an observational study.
OBJECTIVE
To determine the risk factors for venous thromboembolism (VTE) and the rates of prophylactic measures used in acutely ill medical patients.


METHODS
Prospective observational study.


METHODS
Academic tertiary care medical center.


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


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.


CONCLUSIONS
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.
Peterman
Carla M
CM
Department of Pharmacy Services, University of Maryland Medical Center, Baltimore, Maryland, USA.
Kolansky
Daniel M
DM
Spinler
Sarah A
SA
D000046:Academic Medical Centers; D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000188:drug therapy; D001249:Asthma / Q000150:complications / Q000188:drug therapy; D004334:Drug Administration Schedule; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy; D006493:Heparin / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000188:drug therapy; D012307:Risk Factors; D053828:Stockings, Compression; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control*; D020246:Venous Thrombosis / Q000209:etiology / Q000517:prevention & control*
D000925:Anticoagulants; D006493:Heparin