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Efforts to increase physicians' ordering of venous thromboembolism (VTE) prophylaxis in hospitalized patients have been largely successful. However, has VTE-prophylaxis awareness led to indiscriminate use? To find out, researchers examined medical records of ≈45,000 patients admitted for ≥2 days to non–intensive care units in 52 Michigan hospitals. The Padua Prediction Score (J Thromb Haemost 2010; 8:2450) was used to determine risk for VTE. Excessive prophylaxis was defined as pharmacologic or mechanical prophylaxis for low-risk patients, pharmacologic prophylaxis in high-risk patients with any contraindication to anticoagulation, or both pharmacologic and mechanical prophylaxis in any patient.
Most patients (73%) were at low risk; VTE prophylaxis was provided for 78% of low-risk patients. High-risk patients with contraindications to pharmacologic prophylaxis received it 27% of the time, and 32% of high-risk patients without contraindications received excessive prophylaxis (i.e., both pharmacologic and mechanical). VTE prophylaxis was not provided for 22% of high-risk patients.
Grant PJ et al. Use of venous thromboembolism prophylaxis in hospitalized patients. JAMA Intern Med 2018 May 21; [e-pub]. (https://doi.org/10.1001/jamainternmed.2018.2022)
Comment
Although VTE prophylaxis still is underused at times, the pendulum clearly has shifted toward overtreatment. Clinicians need to be more discriminating about which hospitalized patients actually require VTE prophylaxis. Barriers to more-appropriate use of prophylaxis might include the perception that nearly all hospitalized patients are at high VTE risk and variable availability of user-friendly, point-of-care tools that can direct decision making about VTE prophylaxis when clinicians enter hospital admission orders.