Abstract
Background
Venous thromboembolism (VTE) prophylaxis in acutely ill medical patients has been
shown to be safe and effective. Underutilization of this patient safety practice may
result in avoidable mortality and morbidity.
Objectives
We aimed to determine the proportion of hospitalized, acutely ill medical patients
across Canada who were eligible to receive thromboprophylaxis and to evaluate the
frequency, determinants and appropriateness of its use.
Patients/Methods
CURVE is a national, multicenter chart audit of 29 Canadian hospitals. Data were collected
on consecutive patients admitted to hospital for an acute medical illness during a
defined 3-week study period. Information on demographic and clinical characteristics,
risk factors for VTE and bleeding and use of VTE prophylaxis were recorded. The indications
for and appropriateness of VTE prophylaxis were assessed using pre-specified criteria
based on international consensus guidelines. Multivariable analyses were performed
to identify determinants of prophylaxis use.
Results
Of the 4124 medical admissions screened over the study period, 1894 patients (46%)
were eligible for study inclusion. The most common specified admitting diagnoses were
severe infection (28%), COPD exacerbation or respiratory failure (12%), malignancy
(9%) and congestive heart failure (8%). Thromboprophylaxis was indicated in 1702 (90%)
study patients. Overall, some form of prophylaxis was administered to 23% of all patients.
However, only 16% received appropriate thromboprophylaxis. Factors independently associated
with greater use of prophylaxis included internist (vs. other specialty) as attending
physician (OR 1.33, 95% confidence interval (CI) [1.03, 1.71]), university-associated
(vs. community) hospital (OR 1.46, 95% CI [1.03, 2.07]), immobilization (per day)
(OR 1.60, 95% CI [1.45, 1.77]), presence of ≥1 VTE risk factors (OR=1.78, 95% CI [1.35, 2.34]) and duration of hospitalization (per day of stay) (OR 1.05,
95% CI [1.03, 1.07]), however, use of prophylaxis was unacceptably low in all groups.
Patients with cancer had a significantly reduced likelihood of receiving prophylaxis
(OR=0.40, 95% CI [0.24, 0.68]). Presence of risk factors for bleeding did not influence
the use or choice of prophylaxis.
Conclusion
Most patients hospitalized for medical illness had indications for thromboprophylaxis,
yet only 16% received appropriate prophylaxis. Efforts should be made to elucidate
the reasons that underlie the very low rate of thromboprophylaxis in medical patients
and to develop and test strategies to improve implementation of this patient safety
practice.
Abbreviations:
UFH (unfractionated heparin), LMWH (low molecular weight heparin), VTE (venous thromboembolism), Adm (admitting diagnosis)Keywords
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Article info
Publication history
Accepted:
January 12,
2006
Received in revised form:
January 5,
2006
Received:
October 14,
2005
Identification
Copyright
© 2006 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
