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VTE prophylaxis often overused in low-risk patients


 

Background: Per Chest guidelines, VTE prophylaxis is recommended for hospitalized patients at increased risk for VTE but is not recommended for low-risk patients. Risk stratification can be guided by the Padua Prediction Score to categorize patients.

Dr. Joshua Marr

Study design: Multicenter observational study.

Setting: A total of 52 U.S. hospitals (Michigan Hospital Medicine Safety Consortium database).

Synopsis: Patients admitted during Jan. 1, 2015–Dec. 21, 2016, to 52 non–intensive care medical units for 2 or more days were analyzed and stratified as high or low risk for VTE using the Padua Prediction Score. Excessive VTE prophylaxis was defined as low-risk patients prescribed pharmacologic or mechanical prophylaxis, high-risk patients receiving therapy despite a contraindication to prophylaxis, or any patient who received both mechanical and pharmacologic therapy. Underuse of VTE prophylaxis included high-risk patients who did not receive pharmacologic or mechanical prophylaxis. Of the 44,775 patients included in the study, 32,549 were low risk, and 77.9% (25,369 patients) received excessive VTE prophylaxis. Overtreatment also was present in high-risk patients with and without a contraindication to VTE prophylaxis (26.9% and 32.3%, respectively). Underuse of VTE prophylaxis occurred in 2,693 high-risk patients (22%).

Bottom line: Patients who are at low risk for VTE by Padua Prediction Score often are prescribed pharmacologic or mechanical prophylaxis that may be unnecessary. Overuse of VTE prophylaxis was more common than is underuse.

Citation: Grant PJ et al. Use of venous thromboembolism prophylaxis in hospitalized patients. JAMA Intern Med. 2018 Aug 1;178(8):1122-4. Published online May 21, 2018.

Dr. Marr is assistant professor of medicine and an academic hospitalist, University of Utah, Salt Lake City.

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