[Thromboembolic prophylaxis in hospitalized medical patients].
BACKGROUND
The risk of venous thromboembolism (VTE) ranges between 15 and 40% for patients hospitalized for certain medical conditions. Clinical studies have shown that prophylactic treatment with low molecular weight heparins (LMWH) reduces the risk of VTE from 15 to 6%. The aim of this study was to evaluate the use of thromboprophylaxis among hospitalized medical patients after the introduction of clinical guidelines.


METHODS
A retrospective chart review was conducted among patients hospitalized for pneumonia, chronic obstructive pulmonary disease (COPD) and heart failure at Tromsø University Hospital during 2000-2001 and 2003-2004, i.e. before and after introduction of guidelines for thromboprophylaxis. Demographic data, risk factors for VTE and use of thromboprophylaxis were recorded.


RESULTS
434 hospitalizations were included. According to the guidelines, prophylaxis was indicated in 307 (71%) hospitalizations, and LMWH was prescribed in 62 (20%) hospitalizations. There was a non-significant increase in the use of prophylaxis from 18% to 23% after the introduction of clinical guidelines (p = 0.3). Acute myocardial infarction, acute infection and immobilization were significant predictors for prophylaxis.


CONCLUSIONS
This study indicates insufficient adherence to clinical guidelines for thromboprophylaxis to patients at risk of VTE in internal medicine. There is potential for improvement of prophylactic treatment to avoid serious VTE among hospitalized medical patients.
Braekkan
Sigrid
S
Center for Atherothrombotic Research in Tromsø, Universitetet i Tromsø, 9037 Tromsø. sigrid.braekkan@fagmed.uit.no
Grimsgaard
Sameline
S
Hansen
John-Bjarne
JB
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D019983:Guideline Adherence; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D013923:Thromboembolism / Q000517:prevention & control*; D015912:Thrombolytic Therapy; D020246:Venous Thrombosis / Q000517:prevention & control*
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight