Chest
Clinical InvestigationsPULMONARY VASCULATURENew Onset of Venous Thromboembolism Among Hospitalized Patients at Brigham and Women’s Hospital Is Caused More Often by Prophylaxis Failure Than by Withholding Treatment
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)
- et al.
Prevention of venous thromboembolism
Chest
(1998) - et al.
Utilization of venous thromboembolism prophylaxis in the medical intensive care unit
Chest
(1994) - et al.
Limitations of compression ultrasound for the detection of symptomless postoperative deep vein thrombosis
Lancet
(1994) - et al.
The efficacy of pneumatic compression stockings in the prevention of pulmonary embolism after cardiac surgery
Chest
(1996) Prevention of venous thromboembolism: international consensus statement (guidelines according to scientific evidence)
Int Angiol
(1997)- et al.
Venous thromboembolism occurs frequently in patients undergoing brain tumor surgery despite prophylaxis
J Thromb Thrombolysis
(1999) - et al.
Ventilation-perfusion scintigraphy in the PIOPED study: Part II. Evaluation of the scintigraphic criteria and interpretations
J Nucl Med
(1993)
Cited by (204)
Overuse and underuse of thromboprophylaxis in medical inpatients
2023, Research and Practice in Thrombosis and HaemostasisExtended prophylaxis for venous thromboembolism: A step forward or a step back?
2023, European Journal of Internal MedicinePost-discharge thrombosis and bleeding in medical patients: A novel risk score derived from ubiquitous biomarkers
2021, Research and Practice in Thrombosis and HaemostasisSafety and effectiveness of thromboprophylaxis use in hospitalized elderly medical patients at a Saudi tertiary care center
2021, Saudi Pharmaceutical JournalPrescribing patterns and outcomes of venous thromboembolism prophylaxis in hospitalized medical and cancer patients: Observations from the Ottawa Hospital
2021, Thrombosis ResearchCitation 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.
Two novel risk factors for postoperative venous thromboembolism: A reconsideration of standard risk assessment and prophylaxis
2020, American Journal of Surgery