Venous thromboembolism (VTE) prophylaxis is important, both in the inpatient and outpatient settings. This analysis evaluated VTE prophylaxis patterns across both settings in US critical care patients.
VTE prophylaxis patterns from January 2005 to December 2007 were assessed by cross-matching data from Premier's PerspectiveÖ discharge database to the Ingenix LabRx® I3 outpatient and inpatient US database. Medical (cancer, heart failure, severe lung disease or infectious disease) or surgical (abdominal or major orthopedic surgery) patients who were admitted to an intensive care unit for >1 day and who had no contraindications to anticoagulation were included. Inpatient anticoagulant groups were assigned based on the drug received on the final day of hospital stay. These patients were then summarized by their outpatient VTE prophylaxis use. Patients were evaluated for drug utilization during and after an acute episode (hospitalization).
Overall, 60.4% of the 1,279 discharges included in the analysis received anticoagulation during their hospital stay (Table), with 23.5% receiving unfractionated heparin and 23.0% receiving enoxaparin. In the outpatient setting, 95.7% of patients did not fill their anticoagulation script within 30 days of discharge. Of the 55 patients that did receive outpatient anticoagulation, 38 patients received warfarin and a further 10 patients received both warfarin and enoxaparin. The reasons for warfarin use were not studied in this analysis.
This unique analysis investigated VTE prophylaxis patterns from the inpatient to outpatient settings. Although 60% of patients received inpatient prophylaxis, only 4% continued during the outpatient phase. The current practice demonstrates that VTE prevention is not occurring across the continuum of care.
Even though it may seem intuitive that adequate VTE prophylaxis should occur across the continuum of care, further research is needed to better understand the reasons and propose appropriate solutions to improve quality of care.
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 abstract 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