Prophylaxis for Venous Thromboembolism in General Medical Patients: RESULTS

16 Sep
2010

A total of 124 patients were admitted with a primary diagnosis of exacerbation of CHF or COPD during the study period (Table 1). Of these, 67 were excluded, most because of active anticoagulation before or at the time of admission to hospital. The demographic characteristics and risk factors of the 57 patients included in the study are reported in Table 2. The baseline characteristics of the patients with CHF were similar to those of the patients with COPD.

Table 1. Characteristics of Patients Included in and Excluded from Study


Characteristic


No. (%)
of Patients


Charts reviewed


124




(100)


Patients included


57


(46)


COPD only


29


(51)


CHF only


24


(42)


Both COPD and CHF


4


(7)


Patients excluded


67


(54)


Active anticoagulation


38


(57)


Cancer (past or current)


15


(22)


Critical care


11




(16)


Surgery


3


(4)



COPD


=


chronic obstructive pulmonary disease, CHF


=


congestive heart failure.


*Percentages within the inclusion and
exclusion groups were calculated according to the number of patients in
each group.

Table 2. Demographic Characteristics of 57 Patients Included in Study


Characteristic


No. (%)
of Patients


Sex


Men


37


(65)


Women


20


(35)


Mean age (years)


80


Mean length of stay (days)


19


Risk factor


Prolonged immobility (confined to bed
for more than 72 h)


41


(72)


Acute infection


39


(68)


Older age (> 75 years)


32


(56)


Obesity (> 20% over ideal body weight)


4


(7)



Previous VTE (more than


1


year ago)


1


(2)


Inflammatory bowel disease


3


(5)



2

or
more risk factors


48


(84)



VTE


=


venous thromboembolism. *Except where otherwise indicated

During the study period, which followed the educational intervention, 13 (46%) of the 28 patients with CHF exacerbations and 10 (30%) of the 33 patients with COPD exacerbations received VTE prophylaxis. The poor rate of prophylaxis, despite the educational intervention (Table 3), prompted the survey of physicians, described above. Of the 285 surveys that were mailed, 46 (16%) were returned. Most respondents attributed the low rate of prophylaxis to oversight and lack of awareness of current guidelines and indications (Table 4).
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Table 3. Use of VTE Prophylaxis before and after Educational Intervention

No. (%) of Patients Receiving LDUH or LMWHi n Accordance with Guidelines
CHF COPD All patients
Initial audit (April 1, 1999, to March 31, 2000) 29/155 (19) 37/110 (34) 66/265 (25)

Table 4. Perceived Barriers to VTE Prophylaxis (n = 46)


Perceived Barrier
No.



(%)
of


Physicians*


Unaware of indication
and current guidelines


19


(41)


Oversight


25


(54)


Risks exceed benefits


9


(20)


Cost


2


(4)

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