To assess patient characteristics, risk factors and anticoagulation treatment and prophylaxis of venous thromboembolism (VTE) in patients enrolled in a national multicenter database.
A retrospective, cohort study of randomly selected hospital inpatients was performed at 38 hospitals in the United States. Twenty-one teaching hospitals, 13 community hospitals, and 4 Veterans Administration hospitals were included. Patients treated between July, 2000 and June, 2003 with a diagnosis of deep vein thrombosis (DVT) and/or pulmonary embolism (PE), or receiving total knee replacement (TKR), total hip replacement (THR) or hip fracture repair (HFxR) surgery were randomly selected. Those equal to or greater than 18 years of age, admitted from or discharged to another hospital were excluded.
Among the 1867 patients included in the analysis, the mean (SD) age was 59 (18) years in 939 patients with a diagnosis of DVT and/or PE and 67 (16) years in 928 patients receiving TKR (39%), THR (30%) or HFxR (31%) surgery. Co-morbidities including obesity, VTE history, malignancy, and immobility were present in 30%, 28%, 27%, and 19% of DVT/PE patients, respectively. Only 56% of DVT/PE patients received low molecular weight heparin (LMWH). Only 25% of patients not discharged on an injectable agent had 5 days of concomitant treatment with LMWH or unfractionated heparin (UFH) and warfarin during hospitalization. Of the orthopedic surgery patients, 14% received either no or inadequate prophylaxis with aspirin only. Discharge anticoagulation was prescribed in 73% of TKR, 73% of THR and 52% of HFxR patients. Of those not continuing prophylaxis after discharge, the mean duration (SD) of prophylaxis was 3.4 (4.0) days.
LMWH is underutilized in both the treatment and prevention of VTE. Duration of both bridge therapy (LMWH or UFH to warfarin) and prophylaxis is inadequate in a large proportion of patients.
Improved treatment and prophylaxis will reduce both mortality and recurrence of VTE.
V.F. Tapson, AstraZeneca