The Standardization of Venous Thromboembolism (VTE) Prophylaxis in Hospitalized Patients and Increase of Physicians' Adherence to Use VTE Prophylaxis in Anadolu Medical Center

CHEST Journal ◽  
2013 ◽  
Vol 144 (4) ◽  
pp. 566A
Author(s):  
Esra Duman ◽  
Hisam Alahdab ◽  
Metin Cakmakci ◽  
Tayfun Enunlu
Keyword(s):  
Venous Thromboembolism ◽  
Medical Center ◽  
Hospitalized Patients ◽  
Vte Prophylaxis

scholarly journals Venous Thromboembolism Prophylaxis and Risk for Acutely Medically Ill Patients Stratified by Different Ages and Renal Disease Status

2019 ◽  
Vol 25 ◽  
pp. 107602961882328 ◽  
Author(s):  
Alpesh Amin ◽  
W. Richey Neuman ◽  
Melissa Lingohr-Smith ◽  
Brandy Menges ◽  
Jay Lin
Keyword(s):  
Venous Thromboembolism ◽  
Renal Disease ◽  
Age Groups ◽  
Disease Status ◽  
The United States ◽  
Hospitalized Patients ◽  
Thromboembolism Prophylaxis ◽  
Vte Prophylaxis ◽  
Medically Ill ◽  
Medically Ill Patients

The objectives of this study were to examine venous thromboembolism (VTE) prophylaxis patterns and risk for VTE events during hospitalization and in the outpatient continuum of care among patients hospitalized for acute illnesses in the United States with stratification by different age groups and renal disease status. Acutely ill hospitalized patients were identified from the MarketScan databases (January 1, 2012-June 30, 2015) and grouped by age (<65, 65-74, ≥75 years old) and whether or not they had a baseline diagnosis of renal disease, separately. Of acutely ill hospitalized patients, 60.1% (n = 10 748) were <65 years old, 15.7% (n = 2803) were 65 to 74 years old, and 24.3% (n = 4344) were ≥75 years old; 32.9% (n = 5892) had baseline renal disease. Among the study cohorts, the majority of patients received no VTE prophylaxis regardless of age or baseline renal status (52.1%-63.6%). Rates of VTE during hospitalization and in the 6 months postdischarge were 4.7%, 4.6%, and 4.5% for patients <65, 65 to 74, and ≥75 years old, respectively, and 6.3% and 3.8% for patients with and without baseline renal disease. The risk for VTE was elevated for 30 to 40 days after index admission regardless of age and renal disease status.

scholarly journals Risk assessment and prevention of venous thromboembolism among hospitalized patients: Results of the regional multicenter study

2021 ◽  
pp. 26-40
Author(s):  
A. B. Sugraliyev ◽  
Sh. S. Aktayeva ◽  
Sh. B. Zhangelova ◽  
S. A. Shiller ◽  
Zh. M. Kussymzhanova ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Multicenter Study ◽  
Bed Rest ◽  
Primary Objective ◽  
Hospitalized Patients ◽  
Public Health Issue ◽  
Medical Patients ◽  
Pharmacological Prophylaxis ◽  
Vte Prophylaxis

Introduction. Venous thromboembolism (VTE) is a major public health issue that is frequently underestimated. The primary objective of this multicenter study was to identify patients at risk for VTE, and to define the rate of patients receiving appropriate prophylaxis in the regions of Kazakhstan.Materials and methods. Standardized case report forms were filled by trained medical doctors on one predefined day in selected hospitals. Data were analyzed by independent biostatistician. Risk of VTE was categorized according to Caprini score which was recommended by 2004 American College of Chest Physicians (ACCP) guidelines.Results. 432 patients from 4 regions of Kazakhstan; 169 (39.10%) medical patients and 263 (60.9%) surgical patients were eligible for the study. Patients were at low (10%), moderate (19.2%), high (33.6%) and very high risk (37.3%) for VTE. The main risk factors (RF) of VTE among hospitalized patients were heart failure (HF), obesity, prolonged bed rest, and the presence of acute non-infective inflammation. From total number of hospitalized patients with RF with indications to VTE prophylaxis, 58.1% of patients received pharmacological prophylaxis and only 24.6% of them received VTE prophylaxis according ACCP. On the other hand, 23.5% patients with the risk of VTE but who were not eligible for it received pharmacological prophylaxis.Conclusion. These results indicate the existence of inconsistency between eligibility for VTE prophylaxis on one hand and its application in practice (p < 0.001). Risk factors for VTE and eligibility for VTE prophylaxis are common, but VTE prophylaxis and guidelines application are low.

Effectiveness and Safety of Twice Daily Versus Thrice Daily Subcutaneous Unfractionated Heparin for Venous Thromboembolism Prophylaxis at a Tertiary Medical Center

2020 ◽  
pp. 089719002096121
Author(s):  
Meghan W. Sorgi ◽  
Erin Roach ◽  
Seth R. Bauer ◽  
Stephanie Bass ◽  
Michael Militello ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Unfractionated Heparin ◽  
Propensity Scores ◽  
Medical Center ◽  
Matched Cohort ◽  
Thromboembolism Prophylaxis ◽  
Full Cohort ◽  
Vte Prophylaxis ◽  
Major Bleed ◽  
Increased Risk

Background: The direct comparison of twice daily (BID) and thrice daily (TID) dosing of subcutaneous low dose unfractionated heparin (LDUH) for venous thromboembolism (VTE) prophylaxis in a mixed inpatient population is not well-studied. Objective: This study evaluated the effectiveness and safety of BID compared to TID dosing of LDUH for prevention of VTE. Methods: Retrospective, single-center analysis of patients who received LDUH for VTE prophylaxis between July and September 2015. Outcomes were identified by ICD-9 codes. A matched cohort was created using propensity scores and multivariate analysis was conducted to identify independent risk factors for VTE. The primary outcome was incidence of symptomatic VTE. Results: In the full cohort, VTE occurred in 0.71% of patients who received LDUH BID compared to 0.77% of patients who received LDUH TID ( p = 0.85). There was no difference in major ( p = 0.85) and minor ( p = 0.52) bleeding between the BID and TID groups. For the matched cohort, VTE occurred in 1.4% of BID patients and 2.1% of TID patients ( p = 0.32). Major bleed occurred in 0.36% of BID patients and 0.52% of TID patients ( p = 0.7), while a minor bleed was seen in 3.4% of BID patients and 2.1% of TID patients ( p = 0.13). Personal history of VTE ( p = 0.002) and weight ( p = 0.035) were independently associated with increased risk of VTE. Conclusion: This study did not demonstrate a difference in effectiveness or safety between BID and TID dosing of LDUH for VTE prevention.

The Impact Of a Standardized Protocol On Thromboprophylaxis, Venous Thromboembolism and Bleeding Rates In Hospitalized Patients With Hematological Malignancies

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 1729-1729
Author(s):  
Erica A. Peterson ◽  
Hayley Merkeley ◽  
Elena Cavazzi ◽  
Leena Chen ◽  
Agnes Y.Y. Lee
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Left Ventricular ◽  
Hospitalized Patients ◽  
Bleeding Complications ◽  
Historical Cohort ◽  
Thrombotic Risk ◽  
Vte Prophylaxis ◽  
Standardized Protocol ◽  
The Impact

Abstract Background Venous thromboembolism (VTE) is a frequent complication in patients with underlying cancer. This risk is higher during hospitalization for acute medical conditions. Consequently, routine thromboprophylaxis is recommended in hospitalized cancer patients. A retrospective review of admissions to the Leukemia/Bone Marrow Transplant (LBMT) unit at our institution between January and June 2010 demonstrated that VTE prophylaxis was prescribed in only 6.6% of admissions. In March 2012, a mandatory VTE risk assessment and thromboprophylaxis protocol was introduced in the LBMT unit as part of a hospital-wide policy to improve thromboprophylaxis compliance for all hospitalized patients. Objectives The primary goal is to assess the impact of the VTE thromboprophylaxis protocol on the use of thromboprophylaxis in the LBMT unit. Secondary aims of this study are to evaluate the incidence of VTE (including catheter-related thrombosis [CRT]) and bleeding after the introduction of the protocol. Methods A retrospective chart review of all admissions to the Vancouver General Hospital LBMT unit between March 1, 2012 and February 28, 2013 was performed (intervention cohort [IC]). Only the first admission for each patient during the study period was included in the analysis. Data were extracted from electronic medical records using standardized forms. The primary outcome, rate of VTE prophylaxis, was compared to historical data from January 2010 to June 2010 (historical cohort [HC]). Results 361 patients were included in the IC and 166 patients were included in the HC. All baseline patient characteristics, thrombotic risk factors and bleeding risk factors were similar between the cohorts with the exception of the presence of thrombocytopenia (82.0% IC vs. 68.7% HC, p=0.001) (Table 1 ). At least one dose of thromboprophylaxis was prescribed in 14.0% of admissions in the IC vs. 6.6% of admissions in the HC. This increase was statistically significant (p=0.01). Despite the low prophylaxis prevalence, VTE was uncommon, occurring in only 1.9% patients in the IC (pulmonary embolism [PE] in 5 patients, CRT in 1 patient and left ventricular thrombus in 1 patient) vs. 2.4% patients in the HC (deep vein thrombosis +/- PE in 3 patients, CRT and PE in 1 patient) (p=0.7). In contrast, bleeding complications were frequent (even in the absence of anticoagulants), with 13.3% of patients in the IC and 19.3% of patients in the HC experiencing at least one bleeding episode (p=0.08). 22 patients (6.1%) in the IC and 8 patients (4.8%) in the HC died during the study period. While fatal bleeding events occurred in 2 patients in each cohort in the absence of anticoagulation, no deaths due to VTE were observed. Conclusions After introduction of a standardized protocol, VTE prophylaxis rate in hospitalized LBMT patients significantly increased by over 2-fold but remains low. No changes in bleeding and VTE rates were observed despite the increase in prophylaxis compliance. Although thrombocytopenia is likely the prime reason for withholding prophylaxis, further review is ongoing to elucidate the reasons why thromboprophylaxis was not prescribed in the majority of patients. Disclosures: No relevant conflicts of interest to declare.

scholarly journals A cross-sectional, multicenter, observational study to assess the prophylaxis of venous thromboembolism in Lebanese and Jordanian hospitals

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Imad Hajj ◽  
Mahmoud AL-Masri ◽  
Kaldoun Bashaireh ◽  
Mohammed Bani Hani ◽  
Shadi Hamouri ◽  
...  
Keyword(s):  
At Risk ◽  
Venous Thromboembolism ◽  
Observational Study ◽  
Confidence Interval ◽  
Multivariate Logistic Regression Analysis ◽  
Hospitalized Patients ◽  
Cross Sectional ◽  
Multicenter Observational Study ◽  
Vte Prophylaxis ◽  
Prophylactic Measures

Abstract Background There is a growing body of evidence showing substantial underuse of appropriate venous thromboembolism (VTE) prophylaxis in patients at risk. In the present study, our goal was to assess the current practices in the use rate of VTE prophylaxis among hospitalized patients in Jordan and Lebanon. Methods A cross-sectional, multicenter, observational study was conducted on 40 centers across Lebanon and Jordan. We included patients who were admitted to the participating hospitals for the treatment of a serious medical or surgical illness. The patients’ records were screened for the fulfillment of inclusion/exclusion criteria during a single assessment visit. The proportion of medical and surgical patients who were at risk of VTE and the thrombo-prophylactic measures employed by physicians for these patients were assessed according to the American College of Chest Physicians (ACCP 2016) guidelines. Results The present study included 704 patients (400 from Jordan and 304 from Lebanon) with a mean age of 54.9 ± 17.5 years. Almost 59% of the patients received prophylaxis treatment in form of pharmacological anticoagulant prophylaxis and/or mechanical prophylaxis. Low molecular weight heparin was the most commonly used anticoagulant for VTE prophylaxis in 366 out of the total 704 (51.9%) patients in the analysis cohort. Two hundred and sixteen patients (52, 95% confidence interval [47.1–56.9%]) received appropriate prophylactic agents out of 415 patients who were eligible for prophylaxis according to the ACCP 2016 guidelines. On the other hand, 199 (72.1, 95% confidence interval [66.4–77.3%) patients received prophylaxis out of 276 ineligible patients. The rate of compliance to guidelines showed wide variations according to the type of hospital, specialty, and the patients’ age. The multivariate logistic regression analysis showed that only age was a significant predictor of appropriate VTE prophylaxis (odds ratio [OR] 1.05, P < 0.001). Conclusion The rates of the appropriate use of VTE prophylaxis are low in Lebanon and Jordan. There is a lack of compliance to guidelines for VTE prophylaxis use for hospitalized patients in both countries.

Betrixaban: A New Oral Factor Xa Inhibitor for Extended Venous Thromboembolism Prophylaxis in High-Risk Hospitalized Patients

2018 ◽  
Vol 52 (6) ◽  
pp. 554-561 ◽  
Author(s):  
Scott G. Garland ◽  
Christina E. DeRemer ◽  
Steven M. Smith ◽  
John G. Gums
Keyword(s):  
Venous Thromboembolism ◽  
High Risk ◽  
Oral Anticoagulant ◽  
Factor Xa ◽  
Hospitalized Patients ◽  
Efficacy And Safety ◽  
Vte Prophylaxis ◽  
Standard Duration ◽  
Extended Duration ◽  
Fxa Inhibitor

Objective: To review the pharmacology, pharmacokinetics, efficacy, and safety of the factor Xa (FXa) inhibitor betrixaban for extended-duration prophylaxis of acute medically ill patients with venous thromboembolism (VTE) risk factors. Data Sources: A MEDLINE/PubMed (January 1990 to October 2017) search was conducted using the following keywords: betrixaban, PRT054021, FXa inhibitor, novel oral anticoagulant, NOAC, direct oral anticoagulant, DOAC, and target specific oral anticoagulant, TSOAC. References of identified articles were searched by hand for additional relevant citations. Study Selection and Data Extraction: We included English-language articles evaluating betrixaban pharmacology, pharmacokinetics, efficacy, or safety in human subjects for VTE prophylaxis. Data Synthesis: Betrixaban is a FXa inhibitor that decreases prothrombinase activity and thrombin generation. Betrixaban efficacy and safety has been compared with that of enoxaparin for prophylaxis of VTE in acutely ill medical patients. In the APEX trial and substudies, extended-duration betrixaban was superior in efficacy to standard-duration enoxaparin in patients at high risk for VTE, including those with elevated D-dimer levels (≥2× upper limit of normal) and of older age (≥75 years). Betrixaban is noninferior to enoxaparin in rates of major bleeding, but the former is associated with more clinically relevant nonmajor bleeding events. Conclusion: Betrixaban is the first oral agent approved for extended-duration VTE prophylaxis in acutely ill hospitalized patients. Extended-duration thromboprophylaxis with betrixaban reduces the risk of VTE compared with standard-duration thromboprophylaxis with enoxaparin but is associated with increased risk of bleeding.

scholarly journals Factors Influencing Prescribers' Decision for Extending Venous Thromboembolism Prophylaxis in the Medical Patient Population following Hospitalization

TH Open ◽  
2020 ◽  
Vol 04 (03) ◽  
pp. e218-e219
Author(s):  
Alex M. Ebied ◽  
Jeremiah Jessee ◽  
Yiqing Chen ◽  
Jason Konopack ◽  
Nila Radhakrishnan ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Medical Center ◽  
Medical Patient ◽  
Outpatient Setting ◽  
Thromboembolism Prophylaxis ◽  
Vte Prophylaxis ◽  
Oral Medications ◽  
New Oral Anticoagulant ◽  
Perceived Benefit ◽  
Medicine Physician

Abstract Introduction Venous thromboembolism (VTE) prophylaxis during hospitalization has clearly defined metrics for risk stratification and practice policy employed to ensure processes of adherence. However, acceptance for practice or even the level and timeline of risk is less clear during the immediate time after hospitalization. With emerging new oral anticoagulant agents, data are available that may influence prescribing in the outpatient setting following hospitalization. A survey was created to determine the level of acceptance or influences for practice surrounding continuation of anticoagulation following hospitalization. Methods This study was designed as a single-center survey of hospitalist and family medicine physician to assess influences to the physician's impression for risk of VTE prophylaxis and knowledge of therapy options. Results Physicians reported depending heavily on medical center protocols for determining anticoagulation at hospital discharge. Prescribing postdischarge anticoagulation was reported to be affected by lack of comfort with prescribing oral medications and concerns with risk of bleeding for all types of anticoagulation outweighing the perceived benefit. Additionally, the decision whether to prescribe these medications at discharge was reported to be related to perceived cost and other patient barriers such as concerns over route of administration. Conclusion Concerns for bleeding were an influence and likely resulted in shorter duration for VTE prophylaxis being prescribed posthospitalization.

scholarly journals Minor Hematochezia Decreases Use of Venous Thromboembolism Prophylaxis in Patients with Inflammatory Bowel Disease

2019 ◽  
Vol 26 (9) ◽  
pp. 1394-1400 ◽  
Author(s):  
Adam S Faye ◽  
Kenneth W Hung ◽  
Kimberly Cheng ◽  
John W Blackett ◽  
Anna Sophia Mckenney ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Venous Thromboembolism ◽  
Bowel Disease ◽  
Hospitalized Patients ◽  
High Yield ◽  
Thromboembolism Prophylaxis ◽  
Vte Prophylaxis ◽  
Factors Associated ◽  
Increased Risk ◽  
Inflammatory Bowel

Abstract Background Despite increased risk of venous thromboembolism (VTE) among hospitalized patients with inflammatory bowel disease (IBD), pharmacologic prophylaxis rates remain low. We sought to understand the reasons for this by assessing factors associated with VTE prophylaxis in patients with IBD and the safety of its use. Methods This was a retrospective cohort study conducted among patients hospitalized between January 2013 and August 2018. The primary outcome was VTE prophylaxis, and exposures of interest included acute and chronic bleeding. Medical records were parsed electronically for covariables, and logistic regression was used to assess factors associated with VTE prophylaxis. Results There were 22,499 patients studied, including 474 (2%) with IBD. Patients with IBD were less likely to be placed on VTE prophylaxis (79% with IBD, 87% without IBD), particularly if hematochezia was present (57% with hematochezia, 86% without hematochezia). Among patients with IBD, admission to a medical service and hematochezia (adjusted odds ratio 0.27; 95% CI, 0.16–0.46) were among the strongest independent predictors of decreased VTE prophylaxis use. Neither hematochezia nor VTE prophylaxis was associated with increased blood transfusion rates or with a clinically significant decline in hemoglobin level during hospitalization. Conclusion Hospitalized patients are less likely to be placed on VTE prophylaxis if they have IBD, and hematochezia may drive this. Hematochezia appeared to be minor and was unaffected by VTE prophylaxis. Education related to the safety of VTE prophylaxis in the setting of minor hematochezia may be a high-yield way to increase VTE prophylaxis rates in patients with IBD.

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