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Education, Teaching, and Quality Improvement |

Evaluating the Use of Thromboprophylaxis in Hospitalized Medical Patients at a Community Hospital

Gustavo Fernandez, MD; Claudia Nieves, MD; Katherine Melhado, DO; Daniel Brito, MD; Jean Bustamante, MD; Peyman Markazi, DO
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Albert Einstein Medical Center, Philadelphia, PA


Chest. 2015;148(4_MeetingAbstracts):487A. doi:10.1378/chest.2270068
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Abstract

SESSION TITLE: Process Improvement in Obstructive Lung Disease Education, Pneumonia Readmissions and Rapid Response Systems II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Prophylaxis of venous thromboembolism (VTE) in hospitalized patients is a challenging therapeutic decision at the time of admission. The objective of this study is to evaluate the prophylaxis given to the medical patients admitted to our hospital using the American College of Chest Physicians recommendations. Taking into consideration the Padua Score (PS), risk of hemorrhage and the glomerular filtration rate (GFR).

METHODS: This is an observational, quality improvement study. A convenience sampling of patients admitted to the internal medicine service, not on current anticoagulation were enrolled. Charts were reviewed and the Padua Score was measured; patients were categorized into high (≥4 points) and low risk (≤4) for development of VTE as well as for developing bleeding. The GFR was used to determine whether low molecular weight heparin (LMWH) or unfractionated heparin (UFH) was appropriate.

RESULTS: A total of 104 patients were reviewed. According to the guidelines high risk for thrombosis was found on 63 patients (60.5%) and low risk on 41 patients (39.5%). In 16 patients (15.3%) there was a high risk of bleeding and 88 had low risk (84.7%). From all the patients requiring thrombosis prophylaxis, LMWH was indicated in 33 patients, UFH in 23 cases, and mechanical prophylaxis on 7 patients. A concordance analysis was performed, it was significant for moderate agreement with a kappa of 0.439 (CI-95% 0.320-0.058) (p<0.05). An agreement was found between the guidelines and the prophylaxis given in 61 cases (58.7%). A discordant decision was found in 43 cases (41.3%). Overutilization of prophylaxis was the most common discrepancy, with a total of 31 cases (29.8%), followed by the use of UFH in 8 patients where LMWH was indicated. Underutilization was found in only 3 cases (2.88%). Medication was refused in some patients due to frequency of the doses.

CONCLUSIONS: There is a multitude of factors to be considered in the decision to initiate prophylaxis for VTE. The PS is recognized as a resource to aid in this decision; although, the importance of bleeding risk and GFR cannot be undermined. At present, guidelines for VTE prophylaxis are not followed on all patients. A computerized VTE prophylaxis advisor will be implemented in our hospital to guide this decision during admissions.

CLINICAL IMPLICATIONS: Thromboprophylaxis for hospitalized medical patients is a complex multifactorial decision. Current guidelines are moderately followed which needs further education and supervision at our hospital

DISCLOSURE: The following authors have nothing to disclose: Gustavo Fernandez, Claudia Nieves, Katherine Melhado, Daniel Brito, Jean Bustamante, Peyman Markazi

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