scholarly journals To Assess the Appropriateness of the Venous Thromboembolism (VTE) Prophylaxis Agent Used Based on the VTE Risk Stratification in Hospitalised Acutely Ill Medical Patients

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 2444-2444
Author(s):  
Maitreyee Rai ◽  
Jian Liang Tan ◽  
Meghana Parsi ◽  
Malvika Duphare ◽  
Mylene S. Go
Keyword(s):  
Venous Thromboembolism ◽  
Risk Stratification ◽  
Community Hospital ◽  
Low Risk ◽  
Secondary Outcome ◽  
Medical Patients ◽  
Inclusion Criteria ◽  
Vte Prophylaxis ◽  
Prophylactic Agent ◽  
Chemical Prophylaxis

Introduction: An estimated 16% of acutely ill medical patients are at risk of developing venous thromboembolism (VTE) in the absence of appropriate VTE prophylaxis. Hence, the appropriate use of risk stratification models such as Padua Prediction Score(PPS) and prophylactic agents is paramount to mitigate the risk of VTE among hospitalized patients. Despite the existence of VTE prophylaxis guidelines published by the American Society of Hematology(ASH), the risk stratification models and VTE prophylactic agents are often either over- or under-utilized by the clinicians. Objective: To determine the characteristics of VTE prophylaxis orders in a community hospital and the rate of PPS utilization by the clinicians in assessing the VTE risk. The secondary outcome is the appropriateness of the prophylactic agent prescribed based on the patients' risk stratification. Method: We conducted a retrospective chart review of 480 hospitalized medical patients for the month of September 2018. We assessed the adherence of our clinicians to the use of PPS and the VTE prophylaxis agents used per the ASH 2018 VTE Guidelines. Inclusion criteria: ≥18-year-old patients admitted to medical service. Exclusion criteria: admission to non-medical services or ICU, on-going anticoagulation therapy, and pregnancy. Statistical analysis was performed to compare the use of VTE prophylactic agents between teaching and non-teaching services. A survey consisting of 9 questions was distributed to 15 resident physicians to assess their understanding of the VTE prophylaxis for hospitalized medical patients per the ASH 2018 recommendations. Results: Based on our inclusion criteria, a total of 333 patients were eligible for data analysis. Only 3.3%(11/333 patients) had a PPS documented. We re-calculated the PPS for the missing data, 222 patients had a PPS of <4 and 111 patients had a PPS of ≥4. Out of 333 patients, 243 of the patients received chemical prophylaxis either alone or in combination with a mechanical agent, 66 of the patients received mechanical prophylaxis, and 24 of the patients received no VTE prophylaxis (Fig.1). No VTE or bleeding events were recorded in any of our patients. Majority of the patients, 70.37% were prescribed unfractionated heparin(UFH), 23.04% received low molecular weight heparin(LMWH), 6.5% received a combined VTE prophylaxis (Fig.1). Notably, 71.62% (159/222) low-risk for VTE (PPS <4) patients were prescribed chemical VTE prophylactic agents either alone or in combination with the mechanical agents (Fig.2). The extra expense incurred secondary to unnecessary chemical prophylaxis for low-risk patients was calculated about $18/patient (based on an average length of stay of 5 days and cost of UFH dosed thrice daily for a total of 15 vials/patient). In our study, expenditure on these 159 patients amounts to $2862/month, and a calculated approximate annual expenditure of $34,000/year. Based on Fisher's exact test there was a statistically significant difference between the teaching and non-teaching services in prescribing VTE prophylactic agents [p=0.026] among patients with PPS<4. The non-teaching service clinicians were less likely to prescribe pharmacologic VTE prophylaxis compared to teaching clinicians [60.75% vs. 72.17%] (Fig.3). Nonetheless, there was no statistical significance between the two services in the use of VTE prophylactic agent in patients with PPS ≥4 [p=0.38]. Our resident survey revealed that 60% of the residents used their clinical judgment for initiating VTE prophylaxis and did not utilize PPS. 80% of them were aware of the ASH panel 2018 guidelines about LMWH being the VTE prophylaxis agent of choice. Conclusion: Our study revealed that PPS remained underused among the clinicians in our community hospital before prescribing VTE prophylactic agent. The selection of appropriate VTE prophylactic agent remained underscored among our clinicians. It was notable that UFH continued to be the most commonly prescribed VTE prophylactic agent among hospitalized medical patients in our hospital. As a result, we are determined to educate, improve, and raise awareness on the use of PPS and prophylactic agent among our clinicians in accordance with the ASH 2018 VTE guidelines. Disclosures No relevant conflicts of interest to declare.

The Incidence of Clinical Venous Thromboembolism and Use of Ambulatory Prophylaxis Methods in Bedridden Acutely Ill Medical Outpatients: The ETAPE Study.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1760-1760 ◽  
Author(s):  
Jean-Luc Bosson ◽  
Denis Pouchain ◽  
Véronique Dubourg ◽  
Isabelle Dubroca ◽  
Jean-François Bergmann
Keyword(s):  
Venous Thromboembolism ◽  
General Practitioners ◽  
Low Risk ◽  
Secondary Outcome ◽  
Medical Illness ◽  
Vte Prophylaxis ◽  
Reduced Mobility ◽  
Medical Outpatients ◽  
At Home

Abstract Introduction Venous thromboembolism (VTE) prophylaxis in hospitalized acutely ill medical patients has become more commonly used in France, especially since the results of the MEDENOX study (Samama et al. N Engl J Med1999;341:793–800) were published. However, the risk for VTE in bedridden acutely ill medical outpatients treated at home by general practitioners is unknown. The aim of the “Evaluation de l’incidence des événements Thromboemboliques veineux et des Modalités Ambulatoires de Prévention du risque thrombo-Embolique en Médecine Générale” ETAPE study was to determine the incidence of clinical VTE in bedridden acutely ill medical outpatients treated at home. Methods Patients ≥40 years, with an acute medical illness leading to reduced mobility ≥48 h and justifying a medical visit at the patients’ home, were consecutively included in this prospective, multicenter, epidemiological study. Exclusion criteria were: reduced mobility due to a surgical procedure, reduced mobility for >1 month, or use of anticoagulant prior to enrollment. The primary outcome measure was the incidence of clinical deep-vein thrombosis (DVT) between days 1 and 21. The secondary outcome was the incidence of VTE (DVT or pulmonary embolism [PE]). Patients were enrolled by 2895 general practitioners, randomly drawn from a database of 25520 physicians. Results Of 17194 patients enrolled, 16532 (96.1%) were evaluable. Patients’ median age was 71 years, 61% were female, and 13% were totally bedridden. Patients had one or more of the following medical conditions: hypertension (39%), venous insufficiency of lower limbs with varicose veins (30%), severe infection (29%), acute rheumatologic episode (27%), and diabetes (15%). Patients’ medical histories included prior DVT (14%), cardiac failure (12%), cancer (9%), and myocardial infarction and stroke (5%). Overall, 35% of patients received VTE prophylaxis. Of enrolled patients, 18% were considered to be at major risk, 25% moderate risk, and 57% low risk for VTE based on classical risk factors for VTE described in published guidelines on VTE prevention. Of these patients, 56%, 38% and 27% received prophylaxis, respectively. The incidences of clinical DVT were 1.9%, 0.9% and 0.7%, in patients at major, moderate or low risk for DVT, respectively. A summary of VTE events at follow-up is shown in Table 1. Conclusion The incidence of clinical VTE (1.1%) observed in this population is similar to that observed in orthopedic surgery patients (1.3–3.3%; Eikelboom JW et al, Lancet2001;358:9–15). Bedridden acutely ill medical outpatients treated at home have a high risk for VTE, a fact that should be considered by physicians when making the decision to provide prophylaxis. Table 1. Incidence of clinical VTE events at follow-up CI, confidence interval Patients, n 16532 Median duration of follow-up, days 20 Median time to DVT diagnosis, days 7 DVT diagnosed, % (95% CI) 0.99 (0.84–1.14) DVT confirmed by ultrasonography or venography, % 78 PE, % 0.20 Clinical VTE, % (95% CI) 1.1 (0.94–1.26)

Disease burden and unmet needs for prevention of venous thromboembolism in medically ill patients in Europe show underutilisation of preventive therapies

2011 ◽  
Vol 106 (10) ◽  
pp. 600-608 ◽  
Author(s):  
Sharon Welner ◽  
Maria Kubin ◽  
Kerstin Folkerts ◽  
Sylvia Haas ◽  
Hanane Khoury
Keyword(s):  
Venous Thromboembolism ◽  
Care Delivery ◽  
Risk Groups ◽  
Considerable Proportion ◽  
Medical Illness ◽  
Medical Patients ◽  
Vte Prophylaxis ◽  
Medically Ill ◽  
Medical Inpatients ◽  
Clear Identification

SummaryIt was the aim of this review to assess the incidence of venous thromboembolism (VTE) and current practice patterns for VTE prophylaxis among medical patients with acute illness in Europe. A literature search was conducted on the epidemiology and prophylaxis practices of VTE prevention among adult patients treated in-hospital for major medical conditions. A total of 21 studies with European information published between 1999 and April 2010 were retrieved. Among patients hospitalised for an acute medical illness, the incidence of VTE varied between 3.65% (symptomatic only over 10.9 days) and 14.9% (asymptomatic and symptomatic over 14 days). While clinical guidelines recommend pharmacologic VTE prophylaxis for patients admitted to hospital with an acute medical illness who are bedridden, clear identification of specific risk groups who would benefit from VTE prophylaxis is lacking. In the majority of studies retrieved, prophylaxis was under-used among medical inpatients; 21% to 62% of all patients admitted to the hospital for acute medical illnesses did not receive VTE prophylaxis. Furthermore, among patients who did receive prophylaxis, a considerable proportion received medication that was not in accord with guidelines due to short duration, suboptimal dose, or inappropriate type of prophylaxis. In most cases, the duration of VTE prophylaxis did not exceed hospital stay, the mean duration of which varied between 5 and 11 days. In conclusion, despite demonstrated efficacy and established guidelines supporting VTE prophylaxis, utilisation rates and treatment duration remain suboptimal, leaving medical patients at continued risk for VTE. Improved guideline adherence and effective care delivery among the medically ill are stressed.

Disseminating a patient-centered education bundle to reduce missed doses of pharmacologic venous thromboembolism (VTE) prophylaxis to a community hospital

2020 ◽  
pp. 251604352096932
Author(s):  
Oluwafemi P Owodunni ◽  
Brandyn D Lau ◽  
Dauryne L Shaffer ◽  
Danielle McQuigg ◽  
Deborah Samuel ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Real Time ◽  
Community Hospital ◽  
Post Intervention ◽  
Patient Centered ◽  
Record System ◽  
Vte Prophylaxis ◽  
Patient Refusal ◽  
Preventable Harm ◽  
Frequent Reason

Background Venous thromboembolism (VTE) is a leading cause of preventable harm in hospitalized patients. However, many doses of prescribed pharmacologic VTE prophylaxis are frequently missed. We investigated the effect of a patient-centered education bundle on missed doses of VTE prophylaxis in a community hospital. Methods We performed a pre-post analysis examining missed doses of VTE prophylaxis in a community hospital. A real-time alert from the electronic health record system facilitated the delivery of a patient education bundle intervention. We included all patient visits on a single floor where at least 1 dose of VTE prophylaxis was prescribed during pre- (January 1, 2018, - November 31, 2018) and post- (January 1 - June 31, 2019) intervention periods. Outcomes included any missed dose (primary) and reasons for missed doses (refusal, other [secondary]) and were compared between both periods. Results 1,614 patient visits were included. The proportion of any missed dose significantly decreased (13.8% vs. 8.2% [OR, 0.56; 95% CI, 0.48, 0.64]) between the pre-post intervention periods. Patient refusal was the most frequent reason for missed doses. In the post-intervention period, patient refusal significantly decreased from 8.8% to 5.0% (OR, 0.54; 95% CI, 0.46, 0.64). Similarly, other reasons for missed doses significantly decreased from 5.0% to 3.2% (OR, 0.62; 95% CI, 0.51, 0.77). Conclusions A real-time alert-triggered patient-centered education bundle developed and tested in an academic hospital, significantly reduced missed doses of prescribed pharmacologic VTE prophylaxis when disseminated to a community hospital.

PS-100 Venous thromboembolism (VTE) prophylaxis for hospitalised medical patients (HMP) with low molecular weight heparin (LMWH)

2015 ◽  
Vol 22 (Suppl 1) ◽  
pp. A176.1-A176
Author(s):  
FI Ferreira Tátá ◽  
MA Pires Rebelo ◽  
ML Grenho Pereira ◽  
NM Ribeiro Landeira ◽  
SM Dias Fanica ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Venous Thromboembolism ◽  
Low Molecular Weight Heparin ◽  
Low Molecular Weight ◽  
Medical Patients ◽  
Vte Prophylaxis

scholarly journals Systematic review on the benefit of graduated compression stockings in the prevention of venous thromboembolism in low-risk surgical patients

2020 ◽  
pp. 026835552095859
Author(s):  
M Machin ◽  
HC Younan ◽  
S Smith ◽  
Safa Salim ◽  
AH Davies ◽  
...  
Keyword(s):  
Systematic Review ◽  
Venous Thromboembolism ◽  
Included Study ◽  
Low Risk ◽  
Surgical Patients ◽  
Cochrane Library ◽  
Compression Stockings ◽  
Vte Prophylaxis ◽  
Eligible Article ◽  
Graduated Compression Stockings

Objectives The aim of this systematic review is to assess the performance of graduated compression stockings (GCS) in comparison to no venous thromboembolism (VTE) prophylaxis in the prevention of hospital-acquired thrombosis in low-risk surgical patients undergoing short-stay procedures. Methods Aligning with PRISMA guidelines, online databases MEDLINE and EMBASE, Cochrane Library® and trial registries were searched. Eligible articles reported the VTE rate in low-risk surgical patients either receiving GCS or no VTE prophylaxis. Results Narrative synthesis was performed on a single eligible article. The included study arm consisted of participants undergoing knee arthroscopy with the use of GCS alone reporting a total of 29 VTE events (4.4%), 16 of which were asymptomatic DVTs (2.4%). Conclusion There is a complete lack of evidence to support the use of GCS in the prevention of HAT for low-risk surgical patients. An adequately powered trial is required to provide level-IA evidence to support this practice.

scholarly journals Prophylaxis of venous thromboembolism in general surgery: guidelines differ and we still need local policies

2011 ◽  
Vol 93 (5) ◽  
pp. 370-374
Author(s):  
D Veeramootoo ◽  
L Harrower ◽  
R Saunders ◽  
D Robinson ◽  
WB Campbell
Keyword(s):  
At Risk ◽  
Venous Thromboembolism ◽  
High Risk ◽  
Risk Groups ◽  
Low Risk ◽  
Vte Prophylaxis ◽  
Risk Patients ◽  
Local Policies ◽  
One Year ◽  
The Uk

INTRODUCTION Venous thromboembolism (VTE) prophylaxis has become a major issue for surgeons both in the UK and worldwide. Sev-eral different sources of guidance on VTE prophylaxis are available but these differ in design and detail. METHODS Two similar audits were performed, one year apart, on the VTE prophylaxis prescribed for all general surgical inpatients during a single week (90 patients and 101 patients). Classification of patients into different risk groups and compliance in prescribing prophylaxis were examined using different international, national and local guidelines. RESULTS There were significant differences between the numbers of patients in high, moderate and low-risk groups according to the different guidelines. When groups were combined to indicate simply ‘at risk’ or ‘not at risk’ (in the manner of one of the guidelines), then differences were not significant. Our compliance improved from the first audit to the second. Patients at high risk received VTE prophylaxis according to guidance more consistently than those at low risk. CONCLUSIONS Differences in guidance on VTE prophylaxis can affect compliance significantly when auditing practice, depending on the choice of ‘gold standard’. National guidance does not remove the need for clear and detailed local policies. Making decisions about policies for lower-risk patients can be more difficult than for those at high risk.

scholarly journals Use of thromboprophylaxis for venous thromboembolism among patients admitted in medical ward

2019 ◽  
Vol 6 (1) ◽  
pp. 83-88
Author(s):  
Ujjawal Paudel ◽  
Prashant Raj Bhatt ◽  
Choodamani Nepal
Keyword(s):  
At Risk ◽  
Venous Thromboembolism ◽  
Acute Infection ◽  
Tertiary Care ◽  
Medical Ward ◽  
Assessment Model ◽  
Medical Patients ◽  
Cross Sectional ◽  
Vte Prophylaxis ◽  
Risk Of Bleeding

 Introductions: Studies have shown inadequate use of prophylaxis for venous thromboembolism (VTE) in hospital admitted medical patients. This study aims to evaluate the use of VTE prophylaxis in admitted medical patients in a tertiary care teaching hospital. Methods: This was a cross sectional observational study for three weeks from 19 March to 8 April 2017 in patients admitted in the medical ward of Patan Hospital, Patan Academy of Health Sciences, Lalitpur, Nepal. Patient charts were reviewed for appropriate VTE prophylaxis as per modified Padua risk Assessment model. Risks of VTE, presence of bleeding risks, demographics (age, BMI), hospital stay were descriptively analysed. Results: Out of 122 patients, 81 (66.4%) were at risk of VTE. Among 81 at risk, 69 were eligible for VTE pharmacoprophylaxis with no risk of bleeding only 29 (42%) received pharmacoprophylaxis and 12 eligible for prophylaxis but with the risk of bleeding did not receive any prophylaxis. Reduced mobility was the most common indication of thromboprophylaxis in 79 (64%), followed by acute infection 50 (41%). Conclusions: There was suboptimal use of thromboprophylaxis in hospital admitted medical patients at risk of venous thromboembolism, VTE.

The International Medical Prevention Registry on Venous Thromboembolism (IMPROVE): Venous Thromboembolism Prophylaxis Practices in Acutely Ill Medical Patients.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1762-1762 ◽  
Author(s):  
Victor F. Tapson ◽  
Herve Decousus ◽  
Jean-Fran[ccedi]ois Bergmann ◽  
Beng H. Chong ◽  
James B. Froehlich ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Major Surgery ◽  
Medical Illness ◽  
Medical Patients ◽  
Median Length ◽  
Thromboembolism Prophylaxis ◽  
Vte Prophylaxis ◽  
Elastic Stockings

Abstract Background Despite consensus group recommendations indicating that medical patients should receive appropriate venous thromboembolism (VTE) prophylaxis, prophylaxis practices remain poorly characterized. This analysis of IMPROVE, a prospective study of acutely ill medical patients, describes in-hospital prophylaxis practices prior to the publication of updated VTE prevention guidelines by the American College of Chest Physicians. Methods Patient recruitment began in July 2002. Patients ≥18 years old, and hospitalized for ≥3 days with an acute medical illness are enrolled consecutively. Exclusion criteria are: therapeutic antithrombotics/thrombolytics at admission; major surgery or trauma during 3 months prior to admission; and VTE treatment begun within 24 hours of admission. Results Data were from 4315 patients (32% from USA) enrolled up to 30 June 2004 in 37 hospitals in 11 countries (76% with 3-month follow-up data). Patients are 50% female, median (IQR) age 69 (50–80) years, median length of hospital stay 8 (5–14) days, median weight 68 (58–80) kg, and 40% were immobile for ≥3 days (median length of immobility 7 [4–14] days, including immobility immediately prior to admission). In-hospital VTE prophylaxis was received by 41% of patients (Table 1). Of patients with no risk factors (44%), one risk factor (40%), or ≥2 risk factors (16%), 25%, 49%, and 67% received prophylaxis, respectively. 12% of IMPROVE patients would have been eligible for inclusion in the MEDENOX study. Of these, only 52% received prophylaxis in hospital. Prophylaxis was provided to 6% of patients during the 3-month follow-up period, and continued in 11% of patients after discharge. Conclusions Only 41% of IMPROVE patients received VTE prophylaxis, with considerable variation in types and regimens of prophylaxis used. While MEDENOX showed the benefits of VTE prophylaxis (enoxaparin 40 mg) in acutely ill medical patients, only half of MEDENOX-eligible patients received prophylaxis. Table 1. Use of in-hospital VTE prophylaxis (N=4315) VTE prophylaxis Patients receiving VTE prophylaxis, % ROW, rest of world; *Excluding elastic stockings and aspirin ≥1 type of VTE prophylaxis* 41 LMWH - USA (Q12h, Qd) 7 (5, 1) LMWH- ROW (Q12h, Qd) 31 (29, 2) UFH - USA (Q12h, Q8h) 28 (15, 11) UFH - ROW (Q12h, Q8h) 6 (5, 0) Intermittent pneumatic compression (USA, ROW) 6 (19, 0) Aspirin (USA, ROW) 4 (7, 3) Elastic stockings (USA, ROW) 6 (3, 8)

Rates of Clinically Apparent Venous Thromboembolism and Death Resulting from Pulmonary Embolism among Unselected Hospitalized Acutely Ill Medical Patients Versus Rates Predicted from Clinical Studies.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 1620-1620
Author(s):  
Franco Piovella ◽  
Frederick A. Anderson ◽  
Hervé Decousus ◽  
Gordon FitzGerald ◽  
Jean-François Bergmann ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Clinical Studies ◽  
Study Data ◽  
Medical Illness ◽  
Medical Patients ◽  
Vte Prophylaxis ◽  
Autopsy Series ◽  
Unselected Sample ◽  
Observational Cohort ◽  
Hospital Deaths

Abstract Background Without evidence from autopsies, the majority of deaths resulting from pulmonary emboli (PE) are indistinguishable from deaths due to other cardiovascular diseases. This has led to a gap in perceptions between the benefits and risks of providing venous thromboembolism (VTE) prophylaxis. In this study, we estimated the incidence of clinically apparent VTE in hospitalized acutely ill medical patients in The International Medical Prevention Registry on Venous Thromboembolism (IMPROVE), and compared this with the expected incidence derived from clinical studies that used autopsy or prospective venographic confirmation of clinically important VTE. Methods Beginning in July 2002, a consecutive, unselected sample of patients who were aged ≥18 years and hospitalized for ≥3 days with an acute medical illness, were enrolled in this observational cohort from 49 hospitals in 12 countries. Up to 31 March 2005, 6946 patients were enrolled. Results Based on autopsy series of all-cause in-hospital deaths reported in the literature, PE is associated with 10% of deaths, is the primary cause in 5%, and is clinically recognized as the primary cause in 1.5% of deaths. A review of clinical studies with mandatory venography resulted in predicted rates of 10% for all VTE and 1% for clinically recognized (confirmed) VTE. In IMPROVE, there were 4/291 (1.4%) deaths due to clinically recognized PE (vs. 4 predicted). There were 79 (1.1%) treated VTE events (vs. 69 predicted). Conclusions Observed rates of death due to PE and clinically recognized VTE in a real-world setting are consistent with predictions from clinical study data. Physicians should be aware of the significant gap that exists between clinically important and clinically evident VTE events. Reliance on the low rates of clinically recognized events to assess the seriousness of this disease can lead to a significant under-estimation of its impact on public health and a consequent failure to realize the proven benefits of VTE prophylaxis in hospitalized acutely ill medical patients.

The National Practice Patterns of Venous Thromboembolism Prophylaxis Post-Cardiothoracic Surgery

2016 ◽  
Vol 30 (4) ◽  
pp. 394-399 ◽  
Author(s):  
Sheena E. Mathew ◽  
Craig J. Beavers ◽  
Elizabeth McNeely
Keyword(s):  
Venous Thromboembolism ◽  
Artery Bypass ◽  
Bypass Graft ◽  
The United States ◽  
Cardiothoracic Surgery ◽  
Thromboembolism Prophylaxis ◽  
Vte Prophylaxis ◽  
Multicenter Survey ◽  
Pharmacologic Prophylaxis ◽  
Chemical Prophylaxis

Background: The rates of venous thromboembolism (VTE) post-cardiothoracic surgery are not well understood. The american college of chest physicians (CHEST) guidelines report weak recommendations for starting VTE prophylaxis post-cardiothoracic surgery. It is suspected that due to the increase in bleed risk, postsurgery initiation of pharmacologic VTE prophylaxis is limited. Objective: The study sought to investigate the use of VTE prevention in US hospitals performing cardiac surgery and the use of mechanical/chemical prophylaxis postoperatively. Methods: This is a multicenter survey distributed to cardiac hospitals in the United States. The survey was distributed through 3 separate listservs. Data were analyzed utilizing descriptive statistics. Results: The majority of the hospitals were academic and/or community and completed coronary artery bypass graft (CABG), valve replacement (mitral/aortic/tricuspid), and aortic repair. It was common for hospitals to start mechanical and pharmacologic prophylaxis post-cardiothoracic surgery on postoperative day (POD) 1 to 2. The anticoagulation most commonly used consisted of unfractionated heparin. Conclusions: The majority of the institutions are initiating therapy POD 1 to 2 with both mechanical and chemical prophylaxis. The full impact of early initiation of VTE prophylaxis is unknown, and more studies are needed to assess the true risks/benefits of these practices.

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