Venous Thromboembolism Prophylaxis in Medical Inpatients and Adherence to Guideline Recommendations: A Prospective Study

Abstract

Background: Venous thromboembolism (VTE) is a common complication during and after hospitalization for medical patients. Previous studies have shown that only about one third of high risk medical patients receives VTE prophylaxis. Guidelines such as the one produced by the American college of Chest Physicians (ACCP) are aimed at reducing hospital associated VTE. The objective of this study was to determine the appropriateness of VTE prophylaxis in medical inpatients at a large teaching hospital. Methods: In a prospective cross-sectional study, VTE prophylaxis were evaluated and the data were recorded during October 2014 to March 2015 in medical wards of "Alzahra" hospital, Isfahan, Iran. A caprini score, a VTE risk factor assessment tool was calculated for each patient based on data collected. Appropriate prophylaxis was determined after examining data, caprini score and prophylaxis regimen according to the ACCP 9th edition guideline. Results: A total of 100 patients met the inclusion criteria and were reviewed. According to the risk stratification, 18 patients classified as low risk, 30 as moderate and 47 as high risk. 66 of patients did not receive appropriate prophylaxis in accordance with the guideline. Adherence to VTE prophylaxis for high-risk patients was 100 for pharmacological prophylaxis and 5 for mechanical prophylaxis. Conclusion: VTE prophylaxis was underutilized in high-risk medical inpatients in our center, on the other hand it is overused in low-risk patients. There is a need to implement a program to improve VTE awareness and prophylaxis. Also the hospital should develop a formal strategy, including a local guideline for VTE prevention.