title: Prophylaxis against venous thromboembolism in hospitalized medically ill patients.
abstract: BACKGROUND
  Many hospitalized medically ill patients are at risk of venous thromboembolism (VTE). Risk factors include prior VTE, older age, immobility, obesity, cardiac or respiratory failure, and cancer (at-risk patients). Although guidelines recommend use of VTE prophylaxis for at-risk patients, many may not receive it.
  
  
  RESULTS
  Using a database linking admission records from >150 US hospitals to health insurance claims, we identified people ≥40 years of age, hospitalized from 2003 to 2008. We excluded patients who: (1) were treated for VTE or hospitalized in the previous 30 days; (2) were admitted for traumatic injury or surgery; (3) had hypercoagulability at admission; or (4) received therapeutic dosages of low-molecular weight heparin, unfractionated heparin, or fondaparinux at admission. We examined the use of VTE prophylaxis (both pharmacological and nonpharmacological) on day 1 or 2 in hospital among at-risk patients; predictors of receipt of prophylaxis were examined using multivariate logistic regression. The study population consisted of 49 948 patients, of whom 34 374 (69%) were at risk. Only 18% of at-risk patients received VTE prophylaxis on day 1 or 2 in hospital, typically with low-molecular weight heparin (56% of patients receiving prophylaxis), intermittent pneumatic compression (25%), warfarin (16%), or graduated compression stockings (11%). Use of prophylaxis exceeded 25% only in patients admitted from nursing homes and those with prior VTE. Although there were several significant predictors of receipt of VTE prophylaxis, model discrimination was relatively poor (C-statistic=0.61).
  
  
  CONCLUSIONS
  The majority of at-risk hospitalized medically ill patients do not receive VTE prophylaxis.
authors.affiliation: Policy Analysis Inc, Four Davis Ct, Brookline, MA 02445, USA.
authors.forename: Trudy
authors.initials: T
authors.lastname: Pendergraft
authors.forename: Xianchen
authors.initials: X
authors.lastname: Liu
authors.forename: John
authors.initials: J
authors.lastname: Edelsberg
authors.forename: Hemant
authors.initials: H
authors.lastname: Phatak
authors.forename: Montserrat
authors.initials: M
authors.lastname: Vera-Llonch
authors.forename: Larry Z
authors.initials: LZ
authors.lastname: Liu
authors.forename: Gerry
authors.initials: G
authors.lastname: Oster
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D000077425:Fondaparinux; D019983:Guideline Adherence; D006493:Heparin / Q000627:therapeutic use; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D007297:Inpatients; D048228:Intermittent Pneumatic Compression Devices / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011134:Polysaccharides / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D012955:Societies, Medical; D014481:United States / Q000453:epidemiology; D054556:Venous Thromboembolism / Q000453:epidemiology / Q000517:prevention & control*; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; D011134:Polysaccharides; D014859:Warfarin; D006493:Heparin; D000077425:Fondaparinux