Chest
Volume 118, Issue 6, December 2000, Pages 1680-1684
Journal home page for Chest

Clinical Investigations
PULMONARY VASCULATURE
New Onset of Venous Thromboembolism Among Hospitalized Patients at Brigham and Women’s Hospital Is Caused More Often by Prophylaxis Failure Than by Withholding Treatment

https://doi.org/10.1378/chest.118.6.1680Get rights and content

Context:

Guidelines to prevent venous thromboembolism(VTE) have been widely distributed and generally have been assumed tobe effective. Therefore, among hospitalized patients, the developmentof VTE is thought to occur in the context of omitted prophylaxis.

Objectives:

To describe hospitalized patients who develop, VTE and to determine whether they received antecedent prophylaxis.

Design:

Case series.

Setting:

Brigham and, Women’s Hospital.

Patients:

Three hundred eighty-fourpatients who developed in-hospital deep venous thrombosis or pulmonaryembolism or who developed VTE within 30 days of prior hospitaldischarge.

Main outcome measures:

The relationship ofdeveloping new-onset VTE to the use or omission of antecedentin-hospital prophylaxis.

Results:

Of the 384identified patients, 272 had deep venous thrombosis alone, 62 hadpulmonary embolism alone, and 50 had deep venous thrombosis andpulmonary embolism. Most were medical service patients; fewer than onefourth were general or orthopedic surgery patients. Overall, 52% hadreceived antecedent VTE prophylaxis. Thirteen deaths (3.4%) wereascribed to pulmonary embolism, and prophylaxis was omitted in only 1of those 13 patients.

Conclusions:

Most deaths frompulmonary embolism among patients hospitalized for other conditionsoccurred in the setting of failed prophylaxis rather than omittedprophylaxis. High-risk patients, especially medical service patients, warrant intensive VTE prophylaxis and close follow-up to ensuresuccessful outcomes.

Section snippets

Materials and Methods

We searched our hospital database for all discharge diagnoses ofsecondary deep vein thrombosis (DVT) and pulmonary embolism (PE),except for neurosurgical patients,4 from January 1995through December 1996. We also searched the database for a principaldiagnosis of DVT or PE among patients previously discharged from BWHwithin 30 days. We then reviewed each chart to confirm the diagnosis of, VTE. PE was diagnosed primarily by high-probability lung scan (38patients), intermediate lung scan with high

Results

We identified 384 patients with VTE: 180 men (46.9%) and 204women (53.1%). Overall, 272 patients had DVT alone, 62 had PE alone, and 50 had concomitant PE and DVT. The ages of the patients spanned awide range (Fig 1).

Secondary VTE developed during the initial hospitalization in 211 of384 patients (55%) and resulted in rehospitalization at BWH within 30days of a previous BWH discharge among 173 of the 384 patients (45%).Of the 173 who were rehospitalized, 69 were men (40%) and 104 werewomen

Discussion

Surprisingly, the majority of secondary VTE occurred in thesetting of failed prophylaxis rather than omitted prophylaxis. This wasespecially apparent in 12 of the 13 patients who died of PE despitereceiving prophylaxis. Secondary VTE affected both genders similarlyand occurred in a wide age range of patients. Almost half of the cohortwas readmitted to BWH after discharge from BWH within the prior 30days. In addition to its impact on morbidity, mortality, andrehospitalization, secondary VTE was

References (14)

There are more references available in the full text version of this article.

Cited by (204)

  • Overuse and underuse of thromboprophylaxis in medical inpatients

    2023, Research and Practice in Thrombosis and Haemostasis
  • Prescribing patterns and outcomes of venous thromboembolism prophylaxis in hospitalized medical and cancer patients: Observations from the Ottawa Hospital

    2021, Thrombosis Research
    Citation Excerpt :

    This trend was seen in both general medical and cancer patients, but was particularly pronounced among the general medical subgroup, where 36.2% of patients did not receive any pharmacologic thromboprophylaxis but had a VTE rate that was nearly half of that observed in patients prescribed initial thromboprophylaxis (0.4% vs 0.7%). This suggests that hospital-associated VTE in medical patients is not necessarily a failure to provide thromboprophylaxis, but in many cases, is a failure of the thromboprophylaxis itself, which has been described in other observational studies as well [22,40,41]. In our study, the choice to prescribe or withhold thromboprophylaxis was made at the discretion of the individual treating physician.

View all citing articles on Scopus
View full text