Prevention of Deep Vein Thrombosis In Patients In the United States with Infectious Diseases

Abstract Abstract 4389 Background: Hospitalized patients with infectious diseases are at risk of venous thromboembolism (VTE), encompassing both deep-vein thrombosis (DVT) and pulmonary embolism (PE). Our analysis evaluated real-world thromboprophylaxis use and DVT/PE rates in patients with infectious diseases in hospital, and for 30 days post-discharge. Methods: Data were extracted from the US Premier Perspective(tm)-i3 Pharma Informatics linked database for patients with infectious disease (International Classification of Diseases Ninth Revision codes for infectious and parasitic diseases, skin infections, chronic infection, and postoperative infection) who had been admitted January 2005–November 2007. Included patients had at least 6 months’ continuous plan enrollment and were aged ≥ 18 years. Patients with a diagnosis of atrial fibrillation were excluded, as were patients with a hospital stay of 0 days or > 30 days. Results: Of the 5,488 at-risk patients analyzed, 31% received inpatient pharmacological or mechanical DVT prophylaxis, and 3.2% received outpatient pharmacological DVT prophylaxis. Mean ± standard deviation duration of prophylaxis was 1.1 ± 2.4 days for inpatients and 0.8 ± 4.6 days post-discharge, with a total duration of 1.9 ± 5.4 days. DVT/PE occurred in 3.61% of patients during hospitalization, and 0.98% of patients were rehospitalized or treated in the outpatient setting for DVT/PE. Conclusions: Our analysis highlights the considerable rate of DVT/PE and the underuse of DVT prophylaxis in hospitals. Furthermore, DVT/PE risk persisted post-discharge, yet few patients received outpatient prophylaxis. Improved prevention of DVT is required across the continuum of care to reduce preventable mortality and morbidity in patients with infectious diseases. Acknowledgment: this study was funded by sanofi-aventis U.S., Inc. The authors received editorial/writing support in the preparation of this abstract provided by Hester van Lier, PhD of Excerpta Medica, funded by sanofi-aventis U.S., Inc. Disclosures: Amin: sanofi-aventis US Inc.: Honoraria, Speakers Bureau. Lin:sanofi-aventis US Inc.: Employment, Research Funding. Wiederkehr:sanofi-aventis US Inc.: Research Funding.

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Real-World Rates of In-hospital and Postdischarge Deep-Vein Thrombosis and Pulmonary Embolism in At-Risk Medical Patients in the United States

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029611405035 ◽

2011 ◽

Vol 17 (6) ◽

pp. 611-619 ◽

Cited By ~ 8

Author(s):

Alpesh N. Amin ◽

Jay Lin ◽

Stephen Thompson ◽

Daniel Wiederkehr

Keyword(s):

Infectious Disease ◽

At Risk ◽

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

The United States ◽

Outpatient Setting ◽

Medical Patients ◽

Vein Thrombosis ◽

Patients With Cancer ◽

Deep Vein

Hospitalized medical patients are at risk of deep-vein thrombosis (DVT) and pulmonary embolism (PE). We evaluated inpatient and postdischarge DVT/PE and thromboprophylaxis rates in US medical patients, using patient admissions from January 2005 to November 2007 in the Premier Perspective™-i3 Pharma Informatics database. Among 15 721 patients with cancer, congestive heart failure, severe lung disease, and infectious disease, 39.0% received inpatient thromboprophylaxis, with the highest rate in patients with cancer (51.9%). In all, 3.4% received outpatient pharmacological prophylaxis. Mean ± SD prophylaxis duration was 2.2 ± 5.7 days. Overall, 3.0% of inpatients had symptomatic DVT/PE, and an additional 1.1% of patients were rehospitalized for DVT/PE or treated in the outpatient setting. Patients with infectious disease had the highest rate of DVT/PE (4.6%). Inpatient DVT/PE and prophylaxis rates of the different medical conditions had a negative correlation ( R 2 = 0.72). This analysis demonstrates the burden of DVT/PE and highlights the underuse of thromboprophylaxis across the continuum of care.

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Deep Vein Thrombosis Prophylaxis: Audit of Practice in General Surgical Patients in a Teaching Hospital

Phlebology The Journal of Venous Disease ◽

10.1177/026835550001500206 ◽

2000 ◽

Vol 15 (2) ◽

pp. 71-74 ◽

Cited By ~ 4

Author(s):

O. Agu ◽

A. Handa ◽

G Hamilton ◽

D. M. Baker

Keyword(s):

Deep Vein Thrombosis ◽

High Risk ◽

Teaching Hospital ◽

Surgical Patients ◽

Thrombosis Prophylaxis ◽

High Risk Patients ◽

Vein Thrombosis ◽

Dvt Prophylaxis ◽

Risk Patients ◽

Deep Vein

Objective: To audit the prescription and implementation of deep vein thrombosis (DVT) prophylaxis in general surgical patients in a teaching hospital. Methods: All inpatients on three general surgical wards were audited for adequacy of prescription and implementation prophylaxis (audit A). A repeat audit 3 months later (audit B) closed the loop. The groups were compared using the chi-square test. Results: In audit A 50 patients participated. Prophylaxis was correctly prescribed in 36 (72%) and implemented in 30 (60%) patients. Eighteen patients at moderate or high risk (45%) received inadequate prophylaxis. Emergency admission, pre-operative stay and inadequate risk assignment were associated with poor implementation of protocol. In audit B 51 patients participated. Prescription was appropriate in 45 (88%) and implementation in 40 (78%) patients (p< 0.05). Eleven patients at moderate or high risk received inadequate prophylaxis. Seven of 11 high-risk patients in audit A (64%) received adequate prophylaxis, in contrast to all high-risk patients in audit B. The decision not to administer prophylaxis was deemed appropriate in 5 of 15 (30%) in audit A compared with 6 of 10 (60%) in audit B. Conclusion: Increased awareness, adequate risk assessment, updating of protocols and consistent reminders to staff and patients may improve implementation of DVT prophylaxis.

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Venous Thromboembolism

10.2310/vasc.2101 ◽

2017 ◽

Author(s):

Guillermo A. Escobar ◽

Peter K. Henke ◽

Thomas W. Wakefield

Keyword(s):

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

Venous Thromboembolism ◽

Lower Extremity ◽

The United States ◽

Laboratory Evaluation ◽

Individual Risk ◽

Vein Thrombosis ◽

Clinical Scenarios ◽

Deep Vein

Deep vein thrombosis (DVT) and pulmonary embolism (PE) comprise venous thromboembolism (VTE). Together, they comprise a serious health problem as there are over 275,000 new VTE cases per year in the United States, resulting in a prevalence of one to two per 1,000 individuals, with some studies suggesting that the incidence may even be double that. This review covers assessment of a VTE event, initial evaluation of a patient suspected of having VTE, medical history, clinical presentation of VTE, physical examination, laboratory evaluation, imaging, prophylaxis against perioperative VTE, indications for immediate intervention (threat to life or limb), indications for urgent intervention, and management of nonemergent VTE. Figures show a modified Caprini score questionnaire used at the University of Michigan to determine individual risk of VTE and the indicated prophylaxis regimen; Wells criteria for DVT and PE; phlegmasia cerulea dolens secondary to acute left iliofemoral DVT after thigh trauma; compression duplex ultrasonography of lower extremity veins; computed tomographic angiogram of the chest demonstrating a thrombus in the pulmonary artery, with extension into the right main pulmonary; management of PE according to Wells criteria findings; management of PE with right heart strain in cases of massive or submassive PE; treatment of DVT according to clinical scenario; a lower extremity venogram of a patient with May-Thurner syndrome and its subsequent endovascular treatment; and various examples of retrievable vena cava filters (not drawn to scale). Tables list initial clinical assessment for VTE, clinical scenarios possibly benefiting from prolonged anticoagulation after VTE, indications for laboratory investigation of secondary thrombophilia, venous thromboembolic risk accorded to hypercoagulable states, and Pulmonary Embolism Rule-out Criteria Score to avoid the need for D-dimer in patients suspected of having PE. This review contains 11 highly rendered figures, 5 tables, and 167 references. Key words: anticoagulation; deep vein thrombosis; postthrombotic syndrome; pulmonary embolism; recurrent venous thromboembolism; thrombophilia; venous thromboembolism; PE; VTE; DVT

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Rate of deep-vein thrombosis and pulmonary embolism during the care continuum in patients with acute ischemic stroke in the United States

BMC Neurology ◽

10.1186/1471-2377-13-17 ◽

2013 ◽

Vol 13 (1) ◽

Cited By ~ 10

Author(s):

Alpesh N Amin ◽

Jay Lin ◽

Stephen Thompson ◽

Daniel Wiederkehr

Keyword(s):

United States ◽

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

The United States ◽

Care Continuum ◽

Vein Thrombosis ◽

Deep Vein

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SEX DIFFERENCES IN THE USE OF INFERIOR VENA CAVA FILTERS IN PATIENTS WITH PROXIMAL LOWER EXTREMITY DEEP VEIN THROMBOSIS IN THE UNITED STATES

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(17)35444-x ◽

2017 ◽

Vol 69 (11) ◽

pp. 2055

Author(s):

Vladimir Lakhter ◽

Chad Zack ◽

Satyajit Reddy ◽

Saurav Chatterjee ◽

Vikas Aggarwal ◽

...

Keyword(s):

United States ◽

Sex Differences ◽

Deep Vein Thrombosis ◽

Inferior Vena ◽

Vena Cava ◽

The United States ◽

Vein Thrombosis ◽

Inferior Vena Cava Filters ◽

Vena Cava Filters ◽

Deep Vein

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Which hospitalized medical patients need deep vein thrombosis (DVT) prophylaxis?

Evidence-Based Practice ◽

10.1097/01.ebp.0000541182.40356.43 ◽

2016 ◽

Vol 19 (3) ◽

pp. E-3

Author(s):

Ho Phong Pham ◽

Dausen Harker

Keyword(s):

Deep Vein Thrombosis ◽

Medical Patients ◽

Vein Thrombosis ◽

Dvt Prophylaxis ◽

Deep Vein

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Travel Medicine

Mayo Clinic Infectious Diseases Board Review ◽

10.1093/med/9780199827626.003.0043 ◽

2012 ◽

pp. 495-515

Author(s):

Abinash Virk

Keyword(s):

Developing Countries ◽

Deep Vein Thrombosis ◽

Infectious Diseases ◽

Travel Medicine ◽

Developed Countries ◽

The Political ◽

Prevention Measures ◽

Altitude Sickness ◽

Vein Thrombosis ◽

Deep Vein

Travel between developing countries and developed countries is increasing every year. Approximately 880 million passengers arrived at international airports in 2009. The increase in travel to Africa has outpaced the increase for all other regions by almost twice, with the rate of growth reaching 8.1% in 2006. Asian and Pacific Rim countries continue to hold substantial travel interest. Travel to the Middle East has kept pace with travel growth despite the political instability there. More people are traveling to destinations that present higher risks of infectious diseases. Knowledge of prevention measures for preventable diseases becomes increasingly important. Management of posttravel illness becomes increasingly important. Subjects covered include preparation for travel, deep vein thrombosis prevention, motion sickness, jet lag, altitude sickness, vaccination and immunization, and traveler's diarrhea.

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