Characterization of Venous Thromboembolism Risk in Medical Inpatients Using Different Clinical Risk Assessment Models

Rafizadeh, Reza; Turgeon, Ricky D.; Batterink, Josh; Su, Victoria; Lau, Anthony

doi:10.4212/cjhp.v69i6.1608

Cited by 10 publications

(9 citation statements)

References 12 publications

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“…Our finding that 69% of patients were stratified at low VTE risk at initiation of therapy is consistent with both external validation studies and a retrospective application of the IMPROVE VTE RAM, which found 63% to 80% of adult medical patients to be at low risk . Use of other VTE RAMs in large databases of medical patients has also categorized more than 75% patients to be low risk …”

Section: Discussionsupporting

confidence: 86%

“…Other RAMs were derived from populations with high percentages of surgical or cancer patients, considered only risk factors present at admission, or in the case of the Padua Prediction model, were empirically generated from a small, single‐centre cohort and found to be poorly predictive of VTE in an external validation model . Moreover, in identifying medical patients at sufficient risk for VTE prophylaxis, the IMPROVE VTE RAM was found to be more restrictive versus the Padua model or an institutional order set designed to meet Canadian accreditation standards in a retrospective chart review . For the assessment of bleed risk, the IMPROVE Bleed RAM remains the only evidence‐derived RAM known to the authors.…”

Section: Introductionmentioning

confidence: 99%

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Reassessment of venous thromboembolism and bleeding risk in medical patients receiving VTE prophylaxis

Tung¹,

Shah³

et al. 2019

Evaluation Clinical Practice

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Rationale, Aims, and Objectives:The majority of hospitalized nonsurgical medical patients receive pharmacological prophylaxis for venous thromboembolism (VTE), and reassessment of changes in thrombosis and bleeding risk factors during hospital admission may represent an opportunity to discontinue unnecessary or unsafe therapy. The use of validated, clinically derived risk assessment models (RAMs) represents a shift towards an individualized, patient-centred approach to VTE prophylaxis. We are interested in using these tools to assess whether risk categories for VTE and bleeding change during admission and to assess whether such changes result in discontinuation of prophylaxis. Our primary objective was to determine whether VTE and bleed risk categories changed during the course of admission to warrant discontinuation of VTE prophylaxis, using the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) VTE and Bleed RAMs, respectively. Secondary objectives were to determine the number of patients whose risk categorizations for VTE and bleeding warranted discontinuation of VTE prophylaxis and to survey whether prophylaxis was continued or discontinued. Methods:A retrospective review was undertaken for a cross-sectional, randomly selected sample of patients who received VTE prophylaxis while admitted to medical wards in a collection of regional hospitals. Results: Of the 351 medical records reviewed, only eight patients (2.3%) changed their VTE risk category and six (1.7%) changed their bleed risk category to warrant discontinuation of VTE prophylaxis. Ninety patients (26%) were at high risk of VTE and low risk of bleed throughout admission, warranting continued VTE prophylaxis. The majority of patients remained at low risk of VTE throughout admission but remained on VTE prophylaxis until discharge. Conclusions: Risk categories for VTE and bleeding for medical patients did not appreciably change throughout hospital admission. Use of VTE RAMs at admission and prior to initiation of therapy should reduce unnecessary prophylaxis in the majority of medical patients who are at low risk of VTE.

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Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Reassessment of venous thromboembolism and bleeding risk in medical patients receiving VTE prophylaxis

Tung¹,

Shah³

et al. 2019

Evaluation Clinical Practice

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“…8 A Canadian study which used Padua and the IMPROVE predictive risk assessment models, only 21.5% and 7.0% of the patients, respectively, were eligible for thromboprophylaxis at the time of admission. 13 The ACCP guidelines recommends anticoagulant thromboprophylaxis for acutely ill hospitalized medical patients at increased risk of thrombosis. For acutely ill hospitalized medical patients at increased risk of thrombosis who are bleeding or are at high risk for major bleeding, it suggests mechanical thromboprophylaxis with graduated compression stockings or intermittent pneumatic compression.…”

Section: Discussionmentioning

confidence: 99%

Use of thromboprophylaxis for venous thromboembolism among patients admitted in medical ward

Paudel¹,

Bhatt²,

Nepal³

2019

J Patan Acad Health Sci

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Introductions: Studies have shown inadequate use of prophylaxis for venous thromboembolism (VTE) in hospital admitted medical patients. This study aims to evaluate the use of VTE prophylaxis in admitted medical patients in a tertiary care teaching hospital. Methods: This was a cross sectional observational study for three weeks from 19 March to 8 April 2017 in patients admitted in the medical ward of Patan Hospital, Patan Academy of Health Sciences, Lalitpur, Nepal. Patient charts were reviewed for appropriate VTE prophylaxis as per modified Padua risk Assessment model. Risks of VTE, presence of bleeding risks, demographics (age, BMI), hospital stay were descriptively analysed. Results: Out of 122 patients, 81 (66.4%) were at risk of VTE. Among 81 at risk, 69 were eligible for VTE pharmacoprophylaxis with no risk of bleeding only 29 (42%) received pharmacoprophylaxis and 12 eligible for prophylaxis but with the risk of bleeding did not receive any prophylaxis. Reduced mobility was the most common indication of thromboprophylaxis in 79 (64%), followed by acute infection 50 (41%). Conclusions: There was suboptimal use of thromboprophylaxis in hospital admitted medical patients at risk of venous thromboembolism, VTE.

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“…Respecto al uso desmesurado de tromboprofilaxis en pacientes que no lo necesitaban, un estudio retrospectivo de 298 pacientes encontró que el 21,5% tenía indicación de tromboprofilaxis según escala PADUA, entendiendose que alrededor del 80% no lo requería [2] , proporción cercana a la nuestra en donde aproximadamente el 60% de los pacientes en quienes se administró tromboprofilaxis farmacológica carecían de indicación. Un estudio colombiano que incluyó a 102 pacientes reportó que no había indicación de tromboprofilaxis en un 38,2% de los pacientes a los que se les prescribió, y que de este total, la causa más frecuente de error fue la aplicación a pacientes con bajo riesgo (46,1%) de VTE [24] .…”

Section: Discussionunclassified

“…La condición de tromboembolia venosa (VTE, del inglés venous thromboembolism), que comprende a la trombosis venosa profunda (TVP) y la embolia pulmonar (TEP), es la tercera causa de enfermedad cardiovascular después del infarto agudo de miocardio (IAM) y el accidente cerebrovascular (ACV); además, continua siendo una patología con alta carga de morbimortalidad en pacientes hospitalizados [1][2][3] .…”

Section: Introductionunclassified

Experiencia en el uso de tromboprofilaxis farmacológica en un hospital colombiano de tercer nivel

et al. 2018

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Objetivo: Describir las características de la población con patologías no quirúrgicas en quien se indicó manejo de tromboprofilaxis farmacológica en un hospital de tercer nivel y determinar la indicación según riesgo de tromboembolia venosa (VTE) y sangrado con las escalas Padua e IMPROVE Bleeding Score. Materiales y métodos: estudio observacional, descriptivo, de corte transversal que incluyó a pacientes > 18 años, con patología no quirúrgica del servicio de medicina interna, con estancia hospitalaria mínima de 48 horas, atendidos entre el 1 de junio de 2015 a 1 de junio de 2016. En la valoración de riesgo de VTE y sangrado se aplicaron las escalas Padua e IMPROVE Bleeding Score, respectivamente. Resultados: se incluyeron 531 pacientes, de los que el 51,78% fueron hombres, con una edad promedio de 66 años y hospitalización de 37,2 días. La indicación farmacológica más empleada fue la heparina de bajo peso molecular (76,3%). De acuerdo a la escala de Padua, solo 225 pacientes (42,37%) tenían un alto riesgo de tener VTE; según la IMPROVE Bleeding Score, 447 (84,18%) pacientes presentaban bajo riesgo de sangrado y 84 pacientes (15,81%) alto riesgo. Además, se observó que los pacientes con puntaje PADUA ≥ 4, el 21,33% tenía puntaje IMPROVE Bleeding Score ≥7, adicionalmente el 20,23% de los pacientes con alto riesgo de sangrado según esta última escala presentó un episodio de sangrado. Conclusión: se evidenció un sobreuso de tromboprofilaxis farmacológica, lo cual se ve reflejado en episodios de sangrado en paciente que no tenían indicado su uso.

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Characterization of Venous Thromboembolism Risk in Medical Inpatients Using Different Clinical Risk Assessment Models

Cited by 10 publications

References 12 publications

Reassessment of venous thromboembolism and bleeding risk in medical patients receiving VTE prophylaxis

Reassessment of venous thromboembolism and bleeding risk in medical patients receiving VTE prophylaxis

Use of thromboprophylaxis for venous thromboembolism among patients admitted in medical ward

Experiencia en el uso de tromboprofilaxis farmacológica en un hospital colombiano de tercer nivel

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