PURPOSE: Chemical prophylaxis against venous thromboembolism (VTE) is indicated for the majority of hospitalized patients. Specific prophylaxis regimens based on weight, renal function, and neuraxial blockade have not been well defined.
METHODS: Data for all patients admitted to our hospital from September 1st, 2009 through December 31st, 2010 was abstracted. We analyzed prophylaxis rates and efficacy, and identified risk factors for adverse outcomes. This project was part of an ongoing quality improvement initiative, and therefore considered exempt by our DCI. Analysis was conducted using PASW 17 (Formerly Statistical Package for Social Sciences 17.0, SPSS Inc, Chicago, IL).
RESULTS: 8945 adult patients were evaluated (mean age 55.4±20.8 years, BMI 28.6±13.6; 60.2% male). There were 2172 (24.3%) patients with ≥1 surgery during admission, 552 (6.2%) with neuraxial blockade for pain control, 2029 (31.6%) were obese (BMI≥30), and 662 (11.6%) had a Creatinine Clearance (CrCl) < 30 ml/min. Patients who received blood products (p<0.001), neuraxial blockade (p=0.005) and those with a CrCl < 30 (p=0.002) experienced more VTE events. Patients with neuraxial blockade (p<0.001), CrCl < 30 (p<0.001), BMI < 30 (p<0.001), and those who had ≥1 surgery (p<0.001) had more bleeding. Using multivariate logistic regression, we found that receiving blood products (OR 1.7; 95% CI: 1.2-2.5), having a CrCl < 30 (OR 1.8; 95% CI: 1.2-2.6), and receiving neuraxial blockade (OR 1.9; 95% CI: 1.2-3.1) increased the risk for VTE. Patients using neuraxial blockade (OR 1.6; 95% CI: 1.2-2.1), those with a CrCl < 30 (OR 1.7; 95% CI: 1.3-2.1), those who had at least one surgery (OR 1.5; 95% CI: 1.2-1.7), and those with a BMI < 30 (OR 1.4; 95% CI: 1.2-1.7) were more likely to experience bleeding.
CONCLUSIONS: Our analysis helps better define risk factors for adverse outcomes in a large, diverse group of adult patients receiving VTE prophylaxis.
CLINICAL IMPLICATIONS: We recommend factoring in patient status with regards to obesity, renal dysfunction, and use of neuraxial blockade when making decisions on the optimal mode of VTE prevention.
DISCLOSURE: The following authors have nothing to disclose: Jacob Collen, Joshua Mitchell, Sarah Petteys, Aaron Holley
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