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Venous Thromboembolism Prophylaxis among Medical Patients at US Hospitals

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Abstract

Background

Chemoprophylaxis is recommended for medical patients at moderate to high risk of venous thromboembolism (VTE) and is now a requirement of the Joint Commission on Accreditation of Healthcare Organizations. To see who receives prophylaxis and how far hospitals will need to go to meet this requirement, we examined VTE prophylaxis patterns at US hospitals.

Methods

We conducted a retrospective cohort study of adult patients with seven medical diagnoses considered to carry moderate to high risk of VTE at 376 acute care facilities in 2004–2005. We excluded patients on warfarin or with hospital stays of <2 days. VTE prophylaxis was assessed by billing codes for any heparin or compression device. We classified patient risk using a VTE risk prediction model.

Results

Of 351,535 patients included, 36% received prophylaxis by hospital day 2. Prophylaxis rates were highest among patients with certain VTE risk factors, including mechanical ventilation (67%), restraints (57%), central lines (55%), obesity (46%), and prior VTE (44%). The median hospital rate was 31% (IQR 19% to 42%); only 3% of hospitals had rates >70%. Compared to patients at low risk of VTE (<0.05%), patients at high risk (>1.0%) were more likely to receive prophylaxis (52% vs. 34%, p < 0.001). Hospitals with high rates of prescribing for high-risk patients also had high rates for low-risk patients.

Conclusions

VTE prophylaxis rates at US hospitals are substantially below Joint Commission targets, even for patients at highest risk of VTE.

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Acknowledgements

This study was supported by a Clinical Scientist Development Award from the Doris Duke Charitable Foundation. The funding source had no role in the study design, analysis or interpretation of the data.

Conflict of Interest

None disclosed.

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Authors and Affiliations

  1. Center for Quality of Care Research, Baystate Medical Center, Springfield, MA, USA

    Michael B. Rothberg MD, MPH, Penelope S. Pekow PhD & Peter K. Lindenauer MD MSc

  2. Division of General Medicine and Geriatrics, Baystate Medical Center, 759 Chestnut Street, Springfield, MA, 01199, USA

    Michael B. Rothberg MD, MPH

  3. Department of Medicine, Tufts University School of Medicine, Boston, MA, USA

    Michael B. Rothberg MD, MPH & Peter K. Lindenauer MD MSc

  4. Department of Biostatistics, University of Massachusetts School of Public Health, Amherst, MA, USA

    Maureen Lahti MBBS, MPH & Penelope S. Pekow PhD

Authors
  1. Michael B. Rothberg MD, MPH
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  2. Maureen Lahti MBBS, MPH
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  3. Penelope S. Pekow PhD
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  4. Peter K. Lindenauer MD MSc
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Corresponding author

Correspondence to Michael B. Rothberg MD, MPH.

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Rothberg, M.B., Lahti, M., Pekow, P.S. et al. Venous Thromboembolism Prophylaxis among Medical Patients at US Hospitals. J GEN INTERN MED 25, 489–494 (2010). https://doi.org/10.1007/s11606-010-1296-y

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  • DOI: https://doi.org/10.1007/s11606-010-1296-y

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