Nonadministration of thromboprophylaxis in hospitalized patients with HIV: a missed opportunity for prevention?
BACKGROUND
Hospitalized patients with human immunodeficiency virus (HIV) appear to be at increased risk of venous thromboembolism. Previous work at our institution has demonstrated that the proportion of doses administered varies between patients and locations.


OBJECTIVE
To compare the proportion of doses of thromboprophylaxis not administered between patients with and without HIV.


METHODS
Using retrospective data, the proportion of nonadministered doses was determined in all hospitalized adults and stratified by HIV status.


METHODS
Large, urban, academic medical center in Baltimore, Maryland.


METHODS
Data were available for 4947 patient visits, 583 of which were by patients with HIV. Most visits by patients with HIV were to a designated HIV care unit.


METHODS
Proportion of doses of thromboprophylaxis not administered, and documented reasons for dose nonadministration.


RESULTS
A total of 42,870 doses were prescribed. The proportion of doses not administered was greater for patients with HIV (23.5%) compared with patients without HIV (16.1%, odds ratio [OR]: 1.59, 95% confidence interval [CI]: 1.49-1.70, P < 0.001). Documented dose refusal accounted for a greater proportion of nonadministered doses in patients with HIV (15.9% vs 10.8%, OR: 1.56, 95% CI: 1.43-1.70, P < 0.0001). On the HIV care unit, the proportion of doses not administered was greater for patients with HIV (26.4% vs 13.1%, OR: 2.39, 95% CI: 1.93-2.96, P < 0.001). Within this unit, documented dose refusal was greater for patients with HIV (13.7% vs 10.7%, OR: 1.32, 95% CI: 1.16-1.51, P < 0.0001).


CONCLUSIONS
Nonadministration and documented refusal of thromboprophylaxis appear to be more common in patients with HIV at our institution.
Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland.
Matthew J
MJ
Newman
Peggy S
PS
Kraus
Kenneth M
KM
Shermock
Brandyn D
BD
Lau
Elliott R
ER
Haut
Deborah B
DB
Hobson
Michael B
MB
Streiff
D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000328:Adult; D000368:Aged; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D015658:HIV Infections / Q000453:epidemiology*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008396:Maryland; D008875:Middle Aged; D012189:Retrospective Studies; D054556:Venous Thromboembolism / Q000517:prevention & control*
D005343:Fibrinolytic Agents