Although a patient's risk of venous thromboembolism (VTE) is refquently first identified in hospital, the risk often persists following hospital discharge. This analysis therefore evaluated in-hospital and post-discharge VTE prophylaxis patterns for US medical and surgical patients.
Premier's PerspectiveÖ inpatient data were cross-matched at the individual patient level with Ingenix LabRx® outpatient data from the I3 database (January 2005–December 2007) to assess VTE prophylaxis patterns in medical and surgical patients at risk of VTE (according to the American College of Chest Physicians 2004 guidelines) and with no contraindications for anticoagulation. Inpatients were assigned to specific groups based on the anticoagulant received in-hospital and were then followed to assess their outpatient prophylaxis use. Drug utilization and clinical practice patterns during and within 30 days after hospitalization were collected and compared descriptively between groups.
Of the 17,629 medical and surgical discharges at risk of VTE and included in this analysis, 10,134 (57.5%) did not receive any anticoagulation at all. Of the remaining 7,495 (42.5%) discharges that did receive anticoagulation, 3,481 (46.4%) received enoxaparin and 1,893 (25.3%) received unfractionated heparin (UFH) (Table). The median length of hospital stay was 3 days, after which 90.5% of patients did not receive any prophylaxis within the following 30 days. In the 1,674 (9.5%) discharges that received outpatient prophylaxis, the most frequently prescribed prophylaxis options were warfarin (970 discharges, 57.9%) and enoxaparin (525 discharges, 31.3%) (Table).
This unique analysis presents both inpatient and outpatient VTE prophylaxis patterns in real-world medical and surgical patients that are at risk of VTE. More than half of patients received no inpatient VTE, with nearly 90% of patients not receiving outpatient prophylaxis.
Further efforts to improve VTE prevention in hospitalized patients are required, with particular emphasis needed on the transition to outpatient prophylaxis.
Alpesh Amin, Grant monies (from industry related sources) Alpesh Amin has received research honorarium from sanofi-aventis U.S. Inc. Amy Ryan is an employee of Premier Inc, which has received research grants from sanofi-aventis, US Inc.; Employee Jay Lin is an employee of sanofi-aventis US, Inc.; Consultant fee, speaker bureau, advisory committee, etc. Alpesh Amin is on the speakers bureau for sanofi-aventis U.S. Inc; Other The authors received editorial/writing support in the preparation of this manuscript funded by sanofi-aventis U.S., Inc. The authors were fully responsible for all content and editorial decisions and received no financial support or other form of compensation related to the development of the manuscript.; No Product/Research Disclosure Information