title: Rates of pharmacologic venous thromboembolism prophylaxis in hospitalized patients with active ulcerative colitis: results from a tertiary care center.
abstract: BACKGROUND
  Inflammatory bowel disease (IBD) patients are at increased risk for venous thromboembolism (VTE) compared to the general population. Practice guidelines recommend pharmacologic prophylaxis for IBD inpatients.
  
  
  OBJECTIVE
  Our aim was to determine the rates of pharmacologic VTE prophylaxis in ulcerative colitis (UC) inpatients at a tertiary referral center. We also assessed potential predictors of pharmacologic prophylaxis.
  
  
  METHODS
  We conducted a retrospective cohort study of 377 UC patients between January 1st, 2007 and December 31st, 2011. The medical record of each patient was examined to determine whether pharmacologic VTE prophylaxis was ordered and administered. We conducted multiple logistic regression to determine predictors of pharmacologic prophylaxis.
  
  
  RESULTS
  The overall VTE pharmacologic prophylaxis rate was 67.6%. The rate of patients admitted to the medical service was 57.4% compared to 93.5% for those admitted to surgery. In medical patients who received pharmacologic VTE prophylaxis, 34.0% of ordered doses were not given compared to 17.4% of doses in surgical patients (P<0.001). In the multiple logistic regression analysis, having an additional VTE risk factor (OR 2.46, 95% CI 1.41-4.30), extensive colitis (OR 2.26, 95% CI 1.32-3.87) or being admitted to a surgical service (OR 12.03, 95% CI 5.29-27.38) was associated with VTE pharmacologic prophylaxis.
  
  
  CONCLUSIONS
  A substantial proportion of medical patients admitted with UC were not ordered for VTE pharmacologic prophylaxis despite current guidelines. Even in patients who were ordered for pharmacologic prophylaxis, one third of doses were not given. Inappropriate prophylaxis may lead to unnecessary morbidity and mortality.
authors.affiliation: Penn State Hershey Inflammatory Bowel Disease Center, Penn State College of Medicine, Hershey, PA, United States; Division of Gastroenterology and Hepatology, Penn State Hershey Medical Center, Hershey, PA, United States. Electronic address: atinsley@hmc.psu.edu.
authors.forename: Andrew
authors.initials: A
authors.lastname: Tinsley
authors.forename: Steven
authors.initials: S
authors.lastname: Naymagon
authors.forename: Laura M
authors.initials: LM
authors.lastname: Enomoto
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Hollenbeak
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Sands
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Ullman
mesh_terms: D000293:Adolescent; D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003093:Colitis, Ulcerative / Q000150:complications*; D005260:Female; D006493:Heparin / Q000627:therapeutic use*; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007388:Internal Medicine; D008297:Male; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013503:Surgery Department, Hospital; D062606:Tertiary Care Centers; D054556:Venous Thromboembolism / Q000209:etiology / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D006493:Heparin
keywords: Deep venous thrombosis;; Inflammatory bowel disease;; Prophylaxis; Pulmonary embolism;; Ulcerative colitis;; Venous thromboembolism;