Thromboprophylaxis in an Academic Medical Center

Abstract

Introduction:

Questions regarding which patients require prophylaxis for thromboembolism, what methods should be used and the appropriate duration of treatment remain unanswered.

Methods and Materials:

A retrospective review from a single academic medical center was undertaken to evaluate prophylactic strategies. Multiple sources of data were used to identify patients who were prophylaxed and those who developed deep vein thrombosis or pulmonary embolism. These data were analyzed to determine factors associated with successful prophylaxis including age, type of prophylaxis and admitting services.

Results:

A total of 22,030 patients were admitted of whom 7520 (36%) received prophylaxis and there were 523 thromboembolic events. Pneumatic compression devices and antiembolic stockings had the lowest incidence of failure, 2.2% and 3.2% respectively. There were significant differences in the rates of prophylaxis used by the five admitting services, being highest in surgery (40.8%) and lowest in gynecology (11.4%). However, these groups had the lowest incidence of venous thromboembolism (4.3%, 2.3%). Both of these groups used pneumatic compression as the method of choice (64.3% and 65.2%).

Conclusions:

Thromboembolism prophylaxis reduces the incidence of DVT and PE, however, our study demonstrates the variable effectiveness of each method in different types of patients. Our data suggest that patient risk of DVT should be individually assessed and an appropriate method of prophylaxis should be applied when warranted.

Keywords

thromboembolism prophylaxis medical specialty

Get full access to this article

View all access options for this article.

References

Hirsh

, Raschke

, Warkentin

T. E.

, Heparin: mechanism of action, pharmacokinetics, dosing consideration, monitoring, efficacy, and safety. Chest, 1995, 108(4), 258S–275S.

Kamran

S. I.

, Downey

and Ruff

R. L.

, Pneumatic sequential compression reduces the risk of deep vein thrombosis in stroke patients. Neurology, 1998, 50, 1683–1688.

Mamdani

M. M.

, Weingarten

C. M.

and Stevenson

J. G.

, Thromboembolic prophylaxis in moderate-risk patients undergoing elective abdominal surgery: decision and cost-effectiveness analyses. Pharamacotherapy, 1996, 16, 1111–1127.

Smith

, Hasty

and Scurr

J. H.

Prophylaxis for deep vein thrombosis — the effect of graduated compression stockings on venous ddistension. American Venous Forum, 1991.

Antiplatelet Trialists' Collaboration, Collaborative overview of randomised trials of antiplatelet therapy — III: reduction in venous thrombosis and pulmonary embolism by antiplatelet prophylaxis among surgical and medical patients. British Medical Journal, 1994, 308, 235–246.

Prandoni

, Lensing

A. W.

and Prins

M. R.

, The natural history of deep vein thrombosis. Seminars in Thrombosis and Hemostasis, 1997, 23, 185–188.

Hume

, Venous ulcers, the vascular surgeon, and the medicare budget. Journal of Vascular Surgery, 1992, 16(8), 671–673.

Anderson

F. A.

Jr. and Audet

A. M.

, Physician practices in the prevention of deep vein thrombosis: the MassPRO DVT study. Orthopedics, 1996, August, 9–11.

Anderson

F. A.

Jr. , Wheeler

H. B.

, Goldberg

R. J.

, Changing clinical practice: prospective study of the impact of continuing medical education and quality assurance programs on use of prophylaxis for venous thromboembolism. Archives of Internal Medicine, 1994, 154(6), 669–677.

10.

Comerota

A. J.

, Katz

and White

, Why does prophylaxis with external pneumatic compression for deep vein thrombosis fail? American Journal of Surgery, 1992, 164, 265–268.

11.

Greenfield

L. J.

, Proctor

M. C.

and Rodriguez

J. L.

, Post-trauma thromboembolism prophylaxis. The Journal of Trauma, 1997, 42, 100–103.

12.

ACCP Consensus Group, Opinions regarding the diagnosis and management of venous thromboembolic disease. ACCP consensus committee on pulmonary embolism. Chest, 1998, 113, 499–504.