Inappropriate prescription of low molecular weight heparins for thromboprophylaxis among older hospitalized patients.
OBJECTIVE
To investigate the prevalence and clinical correlates of overprescribing and underprescribing of low molecular weight heparins (LMWHs) for thromboprophylaxis among older medical inpatients.


METHODS
Eight hundred seventy six patients (mean age 81.5 ± 7.6 years, female gender 57.2 %) enrolled in a multicenter observational study of seven acute care wards of geriatric medicine in Italy. The risk of venous thromboembolism was ascertained by calculating the Padua score for each patient. Patients receiving appropriate prescription of LMHW during stay were compared to those receiving LMHW with a Padua score <4 (overprescribing group). Similarly, patients with a high thromboembolic risk (Padua score ≥4) but not receiving LMHW (underprescribing group) were compared to patients appropriately not receiving LMHW during stay. Independent correlates of overprescribing and underprescribing were investigated by logistic regression analysis.


RESULTS
Overall, 42.8 % of patients had a Padua score ≥4. LMWHs were overprescribed in 7.3 % and underprescribed in 25.2 % of patients. The number of lost basic activities of daily living (BADL) (OR = 0.25; 95 % CI 0.15-0.41) and the number of diagnoses (OR = 0.76; 95 % CI 0.61-0.95) were inversely associated with LMWH overprescription. Conversely, older age (75-84 years: OR = 2.39; 95 % CI 1.10-5.19-85 years or more: OR = 3.25, 95 % CI 1.40-7.61), anemia (OR = 1.80, 95 % CI 1.05-3.16), pressure sores (OR = 4.15, 95 % CI 1.20-14.3), number of lost BADL at the admission (OR = 3.92, 95 % CI 2.86-5.37) and number of diagnoses (OR = 1.29, 95 % CI 1.15-1.44) qualified as significant correlates of LMWH underprescription.


CONCLUSIONS
Underprescription and, to a lesser extent, overprescription still represent an issue among older medical inpatients.


CONCLUSIONS
Implementing risk-stratifying scores into clinical practice may improve appropriateness of LMWHs prescribing during hospitalization.
Unit of Geriatric Pharmacoepidemiology, Research Hospital of Cosenza, Italian National Research Centre on Aging (INRCA), C. da Muoio Piccolo, 87100, Cosenza, Italy.
Sabrina
S
Garasto
Unit of Geriatric Pharmacoepidemiology, Research Hospital of Cosenza, Italian National Research Centre on Aging (INRCA), C. da Muoio Piccolo, 87100, Cosenza, Italy. s_fusco84@yahoo.it.
Sergio
S
Fusco
Center for Medicine of Aging, Policlinico A. Gemelli, University of Sacro Cuore, Rome, Italy.
Graziano
G
Onder
Center for Medicine of Aging, Policlinico A. Gemelli, University of Sacro Cuore, Rome, Italy.
Federica
F
Sganga
Center for Medicine of Aging, Policlinico A. Gemelli, University of Sacro Cuore, Rome, Italy.
Federica
F
Mammarella
Department of Science and Medicine, University of Ferrara, Ferrara, Italy.
Stefano
S
Volpato
Department of Medicine, Institute of Gerontology and Geriatrics, University of Perugia, Perugia, Italy.
Carmelinda
C
Ruggiero
Alzheimer's Disease Clinic, ASL Frosinone, Atina, Italy.
Angela M
AM
Abbatecola
Scientific Direction, Italian National Research Center on Aging (INRCA), Ancona, Italy.
Fabrizia
F
Lattanzio
Unit of Geriatric Pharmacoepidemiology, Research Hospital of Cosenza, Italian National Research Centre on Aging (INRCA), C. da Muoio Piccolo, 87100, Cosenza, Italy.
Andrea
A
Corsonello
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D008297:Male; D010818:Practice Patterns, Physicians'; D018570:Risk Assessment; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000188:drug therapy*
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight
Elderly; Hospital; Inappropriate prescription; Low molecular weight heparins