Compliance with current VTE prophylaxis guidelines and risk factors linked to complications of VTE prophylaxis in medical inpatients: a prospective cohort study in a Spanish internal medicine department

Abstract

ObjectivesTo evaluate the degree of compliance with the current guidelines regarding venous thromboembolism (VTE) prophylaxis in medical patients during admission and to identify risk factors linked to complications of VTE prophylaxis.DesignProspective cohort study.SettingThe Internal Medicine Department of the University Hospital of Santiago de Compostela (tertiary referral hospital).ParticipantsA total of 396 hospitalised, elderly patients who did not undergo surgery and had no active or previous oral anticoagulation or low molecular weight heparin (LMWH) treatment (during the previous year) and who received VTE prophylaxis during admission.Primary and secondary outcome measuresThe degree of compliance with the current guidelines was estimated by calculating PADOVA and IMPROVE indexes in all cases. We analysed the development of the following complications: major and minor bleeding, major and minor haematoma and decrease of platelet count.ResultsWe found that VTE prophylaxis was correctly indicated in 88.4% of patients. We found two (0.5%) cases with major bleeding, 17 (4.3%) with minor bleeding, 30 (7.6%) with decreased platelet count, 29 (7.3%) with major haematoma and 82 (20.7%) with minor haematoma. After multivariate logistic regression analysis, the presence of major haematomas was linked to obesity (OR 4.1; 95% CI 1.8 to 9.2, p=0.001), concomitant antiplatelet treatment (OR 2.7; 95% CI 1.1 to 6.5, p=0.03) and enoxaparin use (OR 3.5; 95% CI 1.1 to 10.9, p=0.029), and the presence of minor haematomas was associated with PADOVA index <4 points (OR 3.1; 95% CI 1.5 to 6.4, p=0.003) and diabetes mellitus (OR 2; 95% CI 1.1 to 3.7, p=0.031).ConclusionsComplications during VTE prophylaxis in elderly hospitalised medical patients are frequent even with correct application of current guidelines. The main factors linked to haematomas were obesity and concomitant antiplatelet treatment, the presence of which should lead physicians to exercise extreme caution. The use of tinzaparin for VTE prophylaxis in these patients could have a better safety profile.

The rational use of thromboprophylaxis therapy in hospitalized patients and the perspectives of health care providers in Northern Cyprus

“…The enoxaparin prescription pattern identified in the present study was inappropriate, similar to the studies by Fahimi et al and Nekoonam B et al As shown in the study by Fahimi et al [27], the improper dosing, administration, and prescription of enoxaparin occur frequently, and health care providers require training programs and the implementation of evidence-based protocols to control prescription patterns. Regarding complications, a study by Novo-Veleiro et al [28] reported wound haematoma (7.3%) and major bleeding (0.5%) as the main complications, while wound haematoma occurred in 16.6% of patients and no major bleeding was noted during and after hospitalization in our study.…”

The Risk Factors of VTE and Survival Prognosis of Patients With Malignant Cancer: Implication for Nursing and Treatment

“…In the thrombosis risk assessment of cancer patients, various relevant laboratory indicators should be fully integrated to make the prevention and treatment of cancer-related VTE more targeted and individualized. 37 Several studies 38,39 have pointed out prophylactic anticoagulation therapy with low-molecular-weight heparin in patients with cancers can improve the patient's prognosis, reduce the risk of VTE and clinical mortality. All anticoagulation therapy should be closely observed for signs of bleeding during use.…”

Prevention of Venous Thromboembolism in 2020 and Beyond

“…The harms of bleeding-including substantial case fatality rates-may be under-appreciated. Many authors have argued that declining rates of VTE in hospitalized patients should be cause for re-appraisal and de-escalation of previous protocols for the use of VTE prophylaxis [7,8]. As the baseline rate of VTE changes, either through time or differing circumstance, we must balance the threats of both underuse and overuse of pharmacologic VTE prophylaxis.…”

“…This approach is easy to implement in patient care, and pharmacologic VTE prophylaxis for medical and surgical inpatients is frequently included in admission order sets for these patients. However, recent evidence suggests the risk of bleeding with anticoagulant thromboprophylaxis negated its benefit in some groups of patients [7][8][9]. Subsequent trials are examining whether it is possible to improve upon this approach by developing a risk prediction tool to identify individuals with high VTE risk who would benefit the most from thromboprophylaxis.…”