title: Prevention of venous thromboembolism: practice patterns in 17 geographically diverse long term care facilities in the United States: part 1 of 2 (an AMDA Foundation project).
abstract: BACKGROUND
  Current guidelines recommend antithrombotic prophylaxis for venous thromboembolism (VTE) using risk assessment, factoring contraindications. This report represents a summary of current practice patterns to prevent VTE in long term care as Phase 1 of a 3-phase educational intervention study. PHASE 1
  
  
  METHODS
  Participants were 376 new admissions/readmissions (77 ± 12 [SD] years; 67% female) from 17 geographically diverse long term care facilities (3260 total beds).
  
  
  METHODS
  The process describes current VTE prophylaxis (VTE-P) practices; a companion article describes the educational intervention (Phase 2) and outcome (Phase 3). Phase 1 data were collected on use of nonpharmacological measures and antithrombotic drugs for VTE-P between July and September 2009.
  
  
  RESULTS
  Indications for VTE-P were evident in 85% of new admissions, of which two-thirds received VTE-P. Contraindications for anticoagulation were observed in 54.8% of admissions, including quality of life or patient/caregiver wishes. Logistic regression analysis predicted no relationship between any indication for or any contraindication to VTE-P and use of VTE-P, suggesting an inadequate understanding of current clinical practice guidelines.
  
  
  CONCLUSIONS
  Residents of long term care have significant comorbidity that poses risk for VTE; although many received VTE-P, contraindications were common, warranting individualized considerations. The likelihood of VTE-P was greatest following orthopedic surgery, severe trauma, and medical illness.
authors.affiliation: New York Medical College and Montefiore Medical Center North, Bronx, NY, USA. dharmarajants@yahoo.com
authors.forename: T S
authors.initials: TS
authors.lastname: Dharmarajan
authors.forename: Aman
authors.initials: A
authors.lastname: Nanda
authors.forename: Bikash
authors.initials: B
authors.lastname: Agarwal
authors.forename: Parag
authors.initials: P
authors.lastname: Agnihotri
authors.forename: G L
authors.initials: GL
authors.lastname: Doxsie
authors.forename: Murthy
authors.initials: M
authors.lastname: Gokula
authors.forename: Ashkan
authors.initials: A
authors.lastname: Javaheri
authors.forename: M
authors.initials: M
authors.lastname: Kanagala
authors.forename: Anna S
authors.initials: AS
authors.lastname: Lebelt
authors.forename: Prasuna
authors.initials: P
authors.lastname: Madireddy
authors.forename: Sourya
authors.initials: S
authors.lastname: Mahapatra
authors.forename: P
authors.initials: P
authors.lastname: Murakonda
authors.forename: S Ram Rao
authors.initials: SR
authors.lastname: Muthavarapu
authors.forename: Mennakshi
authors.initials: M
authors.lastname: Patel
authors.forename: Christopher
authors.initials: C
authors.lastname: Patterson
authors.forename: Kathleen
authors.initials: K
authors.lastname: Soch
authors.forename: Anna
authors.initials: A
authors.lastname: Troncales
authors.forename: Kamal
authors.initials: K
authors.lastname: Yaokim
authors.forename: Robin
authors.initials: R
authors.lastname: Kroft
authors.forename: Edward P
authors.initials: EP
authors.lastname: Norkus
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D005260:Female; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D008485:Medical Audit; D010818:Practice Patterns, Physicians'; D012308:Risk Management; D014481:United States; D054556:Venous Thromboembolism / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants