title: Aggressive venous thromboembolism prophylaxis reduces VTE events in vascular surgery patients.
abstract: OBJECTIVE
  Venous thromboembolism (VTE) is a potentially preventable complication following surgery. There is variation with regard to the most effective mode of prophylaxis. We sought to determine if an aggressive approach to VTE prophylaxis would reduce VTE rates on the inpatient vascular surgical service.
  
  
  METHODS
  Vascular inpatients from a single institution from July 2010 to March 2013 were included in the analysis. A protocol for VTE prophylaxis was implemented on the inpatient vascular surgical service in November 2011. This included subcutaneous (SQ) heparin initiation within 24 h of admission unless deemed inappropriate by the attending, as well as intermittent compression devices (ICD) and compression stockings (CS). The rate of VTE was compared prior to and following the intervention. Patients were compared using AHRQ comorbidity categories, APR-DRG severity of illness, insurance status, and principle procedure. T-tests were used to compare continuous variables and chi-square analysis used to compare categorical variables.
  
  
  RESULTS
  There were 1483 vascular patients in the pre-intervention group and 1652 patients in the post-intervention group. The rate of pharmacologic prophylaxis was 52.57% pre-intervention compared to 69.33% post-intervention (p < 0.001). The rate of pharmacologic or mechanical prophylaxis was 91.76% pre-intervention compared to 93.10% post-intervention (p = 0.54). The overall rate of VTE prior to the intervention was 1.49% compared to after intervention which was 0.38% (p = 0.033). The DVT rate prior to intervention was 1.09% vs 0.189% after intervention (p = 0.0214). The rate of pulmonary embolism trended towards a significant reduction with the intervention (0.681% vs 0.189%, p = 0.095). There were no statistically significant differences in patient groups based on gender, comorbidity category, severity of illness, or insurance type.
  
  
  CONCLUSIONS
  The overall rate of VTE was reduced by 75% after the initiation of a standard protocol for pharmacologic VTE prophylaxis. These findings justify an aggressive approach to VTE prophylaxis in vascular surgery patients.
authors.affiliation: Department of Surgery, Division of Vascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Joel B
authors.initials: JB
authors.lastname: Durinka
authors.affiliation: Department of Surgery, Division of Vascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Todd Eh
authors.initials: TE
authors.lastname: Hecht
authors.affiliation: Department of Surgery, Division of Vascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Layne
authors.affiliation: Department of Surgery, Division of Vascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Jackson
authors.affiliation: Department of Surgery, Division of Vascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Edward Y
authors.initials: EY
authors.lastname: Woo
authors.affiliation: Department of Surgery, Division of Vascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Fairman
authors.affiliation: Department of Surgery, Division of Vascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Jeffery I
authors.initials: JI
authors.lastname: Rohrbach
authors.affiliation: Department of Surgery, Division of Vascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA Grace.wang@uphs.upenn.edu.
authors.forename: Grace J
authors.initials: GJ
authors.lastname: Wang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D016009:Chi-Square Distribution; D005260:Female; D006493:Heparin / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007279:Injections, Subcutaneous; D048228:Intermittent Pneumatic Compression Devices; D008297:Male; D008875:Middle Aged; D015143:Philadelphia; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D012307:Risk Factors; D053828:Stockings, Compression; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects*; D054556:Venous Thromboembolism / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D006493:Heparin
keywords: DVT; PE; VTE; VTE prophylaxis; post-operative VTE; thromboembolism; vascular surgery