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Kemp M, Chan AHY, Harrison J, Rogers H, Zhao A, Kaur H, Tang G, Yang E, Beyene K. Formal and informal venous thromboembolism risk assessment and impact on prescribing of thromboprophylaxis: a retrospective cohort study. Int J Clin Pharm 2023:10.1007/s11096-023-01578-w. [PMID: 37074512 PMCID: PMC10366250 DOI: 10.1007/s11096-023-01578-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/13/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND Hospital-acquired thrombosis (HAT) is a leading cause of preventable death and disability worldwide. HAT includes any venous thromboembolic (VTE) event occurring in-hospital or within 90-days of hospitalisation. Despite availability of evidence-based guidelines for HAT risk assessment and prophylaxis, guidelines are still underutilised. AIM To determine the proportion of patients who developed HAT that could have been potentially prevented with appropriate VTE risk assessment and prophylaxis at a large public hospital in New Zealand. Additionally, the predictors of VTE risk assessment and thromboprophylaxis were examined. METHOD VTE patients admitted under general medicine, reablement, general surgery, or orthopaedic surgery service were identified using ICD-10-AM codes. Data were collected on patient characteristics, VTE risk factors, and the thromboprophylaxis regimen prescribed. The hospital VTE guidelines were used to determine rates of VTE risk assessment and the appropriateness of thromboprophylaxis. RESULTS Of 1302 VTE patients, 213 HATs were identified. Of these, 116 (54%) received VTE risk assessment, and 98 (46%) received thromboprophylaxis. Patients who received VTE risk assessment were 15 times more likely to receive thromboprophylaxis (odds ratio [OR] = 15.4; 95% CI 7.65-30.98) and 2.8 times more likely to receive appropriate thromboprophylaxis (OR = 2.79; 95% CI 1.59-4.89). CONCLUSION A large proportion of high-risk patients who were admitted to medical, general surgery and reablement services and who developed HAT did not receive VTE risk assessment and thromboprophylaxis during their index admission, demonstrating a significant gap between guideline recommendations and clinical practice. Implementing mandatory VTE risk assessment and adherence to guidelines to improve thromboprophylaxis prescription in hospitalised patients may help reduce the burden of HAT.
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Affiliation(s)
- Megan Kemp
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Pharmacy Department, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Amy Hai Yan Chan
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Jeff Harrison
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Hannah Rogers
- Pharmacy Department, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Adele Zhao
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Harleen Kaur
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Genevieve Tang
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Esther Yang
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Kebede Beyene
- School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
- Department of Pharmaceutical and Administrative Sciences, St Louis College of Pharmacy, University of Health Sciences and Pharmacy in St. Louis, 1 Pharmacy Place, St. Louis, MO, 63110, USA.
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Torres-Quintanilla FJ, Azpiri-López JR, Romero-Ibarguengoitia ME, Ponce-Sierra TH, Martínez-Gallegos EP. Improving thromboprophylaxis in the medical inpatients: The role of the resident in an academic hospital. Phlebology 2023; 38:91-95. [PMID: 36537872 DOI: 10.1177/02683555221147472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
INTRODUCTION Venous thromboembolism (VTE) is one of the main causes of preventable in-hospital death. It is recommended for hospitals to have an appropriate thromboprophylaxis (TP) protocol to avoid VTE complications. OBJECTIVE To determine the effect of the resident physician feedback to the staff physician in TP appropriateness after the Caprini RAM score implementation. METHODS Caprini RAM was implemented by the residents in medical patients. Patients were divided in low, moderate, high, and highest-risk groups, with TP recommendation accordingly. In cases with inadequate TP, the resident provided feedback to the staff physician for adjustment. Change to appropriate TP was assessed retrospectively. RESULTS A total of 265 records were included. Before intervention, 193 (72.8%) patients had appropriate TP and post-intervention, 207 (78.1%) patients received adequate TP (p < .001). CONCLUSIONS Feedback from the internal medicine resident to staff physician improves appropriate TP in medical inpatients as a quality of care strategy.
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Affiliation(s)
- Francisco J Torres-Quintanilla
- Department of Internal Medicine, Christus Muguerza Hospital Alta Especialidad, 27808Universidad de Monterrey, San Pedro Garza Garcia, Mexico
| | - José R Azpiri-López
- Department of Cardiology, Christus Muguerza Hospital Alta Especialidad, 27808Universidad de Monterrey, San Pedro Garza Garcia, Mexico
| | - Maria E Romero-Ibarguengoitia
- Department of Endocrinology, Christus Muguerza Hospital Alta Especialidad, 27808Universidad de Monterrey, San Pedro Garza Garcia, Mexico
| | - Tadeo H Ponce-Sierra
- Department of Health Quality, Christus Muguerza Hospital Alta Especialidad, 27808Universidad de Monterrey, San Pedro Garza Garcia, Mexico
| | - Eunice P Martínez-Gallegos
- Department of Health Quality, Christus Muguerza Hospital Alta Especialidad, 27808Universidad de Monterrey, San Pedro Garza Garcia, Mexico
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Güven AT, Altintop SE, Özdede M, Uyaroğlu OA, Tanriöver MD. Quality gap in venous thromboembolism prophylaxis practices in inpatients: Assessment of prophylaxis practices in a University Hospital. Int J Qual Health Care 2021; 33:6322788. [PMID: 34270730 DOI: 10.1093/intqhc/mzab104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 06/06/2021] [Accepted: 07/15/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Venous thromboembolism (VTE) is a prevalent complication of inpatient care, causing high burden of morbidity and mortality. Prophylaxis reduces the events; thus, these practices are promoted. We aimed to assess the VTE prophylaxis practices in the general internal medicine wards of a tertiary-care university hospital and utilize these data to propose quality improvement projects. OBJECTIVE Assess the pharmacological venous thromboembolism prophylaxis utilization by using the Padua Prediction Score and demonstrate the main determinants of inappropriate prophylaxis use. METHODS Electronic medical records were used to collect data cross-sectionally from 1 January 2019 to 30 June 2019. Padua Prediction Score was used to assess the appropriateness of VTE prophylaxis. Underlying health conditions, hospitalization causes, anti-platelets and use of glucocorticoids were also assessed as confounding factors. RESULTS A total of 295 patients were included. Higher proportion of patients who received VTE prophylaxis were obese and had higher rates of diabetes and coronary artery disease. Prophylaxis was more commonly utilized among patients who were elderly, obese, having an acute infection and/or rheumatologic disorder and prolonged bed rest (P ≤ 0.001, P = 0.01, P = 0.22 and P ≤ 0.001, respectively). Thirty-five patients (11.8%) received VTE prophylaxis, despite 89 patients (30.2%) were high-risk patients. In the high-risk group (n = 89), 27 patients (30.3%) received appropriate pharmacological prophylaxis, while 8 patients (3.9%) received VTE prophylaxis in the low-risk group (total n = 206). A considerable percentage of the high-risk population (69.6%) did not receive VTE prophylaxis. DISCUSSION Underuse constitutes a major challenge in our hospital but differing from other institutions, overuse is not a significant issue. Further studies are needed whether VTE prophylaxis improvement implementations uniformly increase appropriate VTE use.
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Affiliation(s)
- Alper Tuna Güven
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Hacettepe district, Ankara 06230, Turkey
| | - Sabri Engin Altintop
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Hacettepe district, Ankara 06230, Turkey
| | - Murat Özdede
- Department of Internal Medicine, Division of General Internal Medicine, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey
| | - Oğuz Abdullah Uyaroğlu
- Department of Internal Medicine, Division of General Internal Medicine, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey
| | - Mine Durusu Tanriöver
- Department of Internal Medicine, Division of General Internal Medicine, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey
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Conhecimento, avaliação de risco e autoeficácia quanto a tromboembolismo venoso entre enfermeiros. ACTA PAUL ENFERM 2020. [DOI: 10.37689/acta-ape/2020ao0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Albertsen IE, Goldhaber SZ, Piazza G, Overvad TF, Nielsen PB, Larsen TB, Søgaard M. Predictors of Not Initiating Anticoagulation After Incident Venous Thromboembolism: A Danish Nationwide Cohort Study. Am J Med 2020; 133:463-472.e5. [PMID: 31606490 DOI: 10.1016/j.amjmed.2019.08.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 08/20/2019] [Accepted: 08/20/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE The purpose of this study was to investigate potential predictors associated with not initiating anticoagulation after incident venous thromboembolism. METHODS We linked Danish nationwide health registries to identify all patients with incident venous thromboembolism from 2003 through 2016. We defined treatment noninitiation as not claiming a prescription for an anticoagulant drug within 30 days after hospital discharge. To identify potential predictors of noninitiation, relative risks (RRs) with 95% confidence intervals (CIs) were calculated adjusting for other compliance-related factors. RESULTS The study included 38,044 patients with incident venous thromboembolism (53.2% female and median age 66.1 years). Of these, 24.1% (n = 9294) were noninitiators. Demographic and condition-related factors that predicted noninitiation included: female sex (RR 1.30; 95% CI, 1.25-1.34), age <30 vs age >65 years (RR 1.18; 95% CI, 1.13-1.33), hospitalization 0-3 days vs >3 days (RR 1.96; 95% CI, 1.87-2.07), incident deep venous thrombosis (RR 1.91; 95% CI, 1.81-2.01), and unprovoked venous thromboembolism (RR 1.13; 95% CI, 1.08-1.17). Socioeconomic factors had less influence on risk of noninitiation. Individual chronic diseases predictive of noninitiation included congestive heart failure (RR 1.27; 95% CI, 1.17-1.37), ischemic heart disease (RR 1.20; 95% CI, 1.13-1.28), and liver disease (RR 1.60; 95% CI, 1.42-1.81). CONCLUSION Up to one-fourth of patients diagnosed with incident venous thromboembolism did not initiate anticoagulant treatment within 30 days after hospital discharge. Identification of clinical predictors of noninitiation may enable implementation of patient-tailored strategies to improve adherence and thereby potentially prevent venous thromboembolism morbidity, mortality, and recurrence.
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Affiliation(s)
- Ida Ehlers Albertsen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Aalborg Thrombosis Research Unit, Aalborg University Hospital, Aalborg, Denmark.
| | - Samuel Zachary Goldhaber
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Gregory Piazza
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Thure Filskov Overvad
- Aalborg Thrombosis Research Unit, Aalborg University Hospital, Aalborg, Denmark; Department of Medicine, North Denmark Regional Hospital, Hjoerring, Denmark
| | - Peter Brønnum Nielsen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Aalborg Thrombosis Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Torben Bjerregaard Larsen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Aalborg Thrombosis Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Mette Søgaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Aalborg Thrombosis Research Unit, Aalborg University Hospital, Aalborg, Denmark
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Mahlab-Guri K, Otman MS, Replianski N, Rosenberg-Bezalel S, Rabinovich I, Sthoeger Z. Venous thromboembolism prophylaxis in patients hospitalized in medical wards: A real life experience. Medicine (Baltimore) 2020; 99:e19127. [PMID: 32049830 PMCID: PMC7035063 DOI: 10.1097/md.0000000000019127] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Venous thromboembolism (VTE) is a preventable cause of morbidity and mortality in acutely ill patients hospitalized in medical departments. Thromboprophylaxis with anticoagulants was shown to be safe and effective in medical patients with high risk to develop VTE. Despite guidelines recommendations, the rate of thromboprophylaxis in those patients is low. The objective of the study was to evaluate the rate of VTE risk assessment in routine medical department practice, the rate of eligible patients for thromboprophylaxis, the rate of patients who received thromboprophylaxis, and their outcome.Medical records of consecutive patients (3000 at 2013, 1000 at 2018) hospitalized in medical department were reviewed, retrospectively, for demographic, clinical characteristics, thromboprophylaxis treatment with enoxaparin and outcome (up to 90 days following discharge). Padua score was used for VTE risk assessment. VTE diagnosis was based on clinical suspicion.The mean patient's age (52.6% females) was 67.95 ± 21.56 years. 21% were eligible for thromboprophylaxis. Routine VTE risk assessment rate increased significantly following its incorporation into quality parameters, but the rate of treated patients was low (22% at 2013; 46% at 2018). The patients who received thromophylaxis were sicker compared to eligible patients without thromboprophylaxis. The rate of symptomatic VTE was low (0.24%; 0.12% and 0.55% for low and high VTE risk, respectively). Thromboprophylaxis did not have significant effect on the low number of VTE events. No major bleeding was observed.Major efforts are still needed to increase the rate of thromboprophylaxis in all eligible medical patients according to the guidelines recommendations.
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Affiliation(s)
- Keren Mahlab-Guri
- Kaplan Medical Center, Rehovot
- Affiliated to the Hebrew University and Hadassah Medical School, Jerusalem, Israel
| | - Monged Shaher Otman
- Kaplan Medical Center, Rehovot
- Affiliated to the Hebrew University and Hadassah Medical School, Jerusalem, Israel
| | - Natalia Replianski
- Kaplan Medical Center, Rehovot
- Affiliated to the Hebrew University and Hadassah Medical School, Jerusalem, Israel
| | - Shira Rosenberg-Bezalel
- Kaplan Medical Center, Rehovot
- Affiliated to the Hebrew University and Hadassah Medical School, Jerusalem, Israel
| | - Irina Rabinovich
- Kaplan Medical Center, Rehovot
- Affiliated to the Hebrew University and Hadassah Medical School, Jerusalem, Israel
| | - Zev Sthoeger
- Kaplan Medical Center, Rehovot
- Affiliated to the Hebrew University and Hadassah Medical School, Jerusalem, Israel
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