PURPOSE: To assess the rate of thromboprophylaxis in at-risk, hospitalized medical patients in accordance with the Sixth ACCP guidelines.
METHODS: Premier’s Perspective™ inpatient administrative database was used to assess the rate of venous thromboembolism (VTE) prophylaxis in acute myocardial infarction, heart failure, severe lung disease, cancer, stroke, trauma, and spinal cord injury patients. Only patients aged 40 or older, with a minimum length of stay of six days, and no contraindications for anti-coagulation were included in the sample. Appropriate thromboprophylaxis was determined by comparing the daily use of anti-coagulants and compression devices, dosage, and duration of prophylaxis with the ACCP recommendations. Trends were assessed by comparing prophylaxis rates for each quarter.
RESULTS: A total of 200,400 hospital discharges from 227 hospitals that consistently submitted data to Perspective between January 2002 and September 2005 were selected for analysis. VTE prophylaxis rates varied significantly across diagnostic groups: 49 percent in ischemic stroke, 43 percent for AMI, 40 percent in heart failure, 31 percent for severe lung disease, 27 percent in cancer, 22 percent for acute spinal cord injury, and 20 percent for non-surgical trauma patients. An average of 33 percent of all at-risk medical patients received ACCP compliant VTE prophylaxis. The longitudinal pattern of compliance suggests that the rate increased slightly from Q1, 2002 (29 percent) to Q3 2005 (37 percent).
CONCLUSION: There is a significant gap in the adherence of VTE prophylaxis to ACCP guidelines although the results indicate improvement over time. It is of great concern that 67 percent of at-risk medical patients in the study did not receive the recommended prophylaxis and that an average of 44 percent did not receive any prophylaxis at all.
CLINICAL IMPLICATIONS: The results indicate that current VTE prophylaxis for at-risk medical patients in hospitals is not optimal. More effort is required to increase awareness of the ACCP recommendations for thromboprophylaxis for at-risk medical patients.
DISCLOSURE: Alpesh Amin, Grant monies (from industry related sources) Funding for this study provided by Sanofi-Aventis US; Consultant fee, speaker bureau, advisory committee, etc. Alpesh Amin, MD, MBA is a paid consultant of Sanofi-Aventis US; Product/procedure/technique that is considered research and is NOT yet approved for any purpose. In this study we evaluated VTE prophylaxis using low-molecular weight and unfractionated heparin and compression devices in medical conditions recommended by the American College of Chest Physicians.