Poor Adherence to Risk Stratification Guidelines Results in Overuse of Venous Thromboembolism Prophylaxis in Hospitalized Older Adults

Pavon, Juliessa M.; Sloane, Richard; Pieper, Carl F.; Colón‐Emeric, Cathleen; Cohen, Harvey J.; Gallagher, David; Morey, Miriam C.; McCarty, Midori; Ortel, Thomas L.; Hastings, S. Nicole

doi:10.12788/jhm.2916

Cited by 17 publications

(18 citation statements)

References 11 publications

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“…Similar to our ndings, a multicenter study from the United States (US) reported that 77.9% of hospitalized patients received excessive VTE prophylaxis without appropriate indication (22). Another retrospective cohort study reported that pharmacological VTE prophylaxis was present in 74% of low-risk patients, who were not eligible for prophylaxis (21). the manuscript; JK shared in data collection and manuscript writing; NS shared in data collection and manuscript writing; CF shared in data collection and manuscript writing…”

Section: Discussionsupporting

confidence: 82%

“…Although the underutilization of VTE prophylaxis in at-risk patients represents a major cause of inhospital mortality and morbidity, inappropriate use of VTE prophylaxis in low-risk patients, when not medically indicated, can have a negative impact on patients' outcomes leading to bleeding and drugs interaction (21). In the present study, we found that 77.97% of the medical patients, who were not eligible for VTE prophylaxis, received prophylactic agents, compared to 66.88% of the surgical patients who were not eligible for VTE prophylaxis.…”

Section: Discussionmentioning

confidence: 99%

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A Cross-sectional, Multicenter, Observational Study to Assess the Prophylaxis of Venous Thromboembolism in Lebanese and Jordanian Hospitals

Elgebaly

Masri

Bashaireh

et al. 2020

Preprint

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Background There is a growing body of evidence showing substantial underuse of appropriate venous thromboembolism (VTE) prophylaxis in patients at risk. In the present study, our goal was to assess the current practices in the use rate of VTE prophylaxis among hospitalized patients in Jordan and Lebanon. Methods A cross-sectional, multicenter, observational study was conducted on 40 centers across Lebanon and Jordan. We included patients who were admitted to the participating hospitals for the treatment of a serious medical or surgical illness. The patients’ records were screened for the fulfillment of inclusion/exclusion criteria during a single assessment visit. The proportion of medical and surgical patients who were at risk of VTE and the thrombo-prophylactic measures employed by physicians for these patients were assessed according to the American College of Chest Physicians (ACCP 2016) guidelines. Results The present study included 704 patients (400 from Jordan and 304 from Lebanon) with a mean age of 54.9 ± 17.5 years. Almost 59% of the patients received prophylaxis treatment in form of pharmacological anticoagulant prophylaxis and/or mechanical prophylaxis. Low molecular weight heparin was the most commonly used anticoagulant for VTE prophylaxis in 366 out of the total 704 (51.9%) patients in the analysis cohort. Two hundred and sixteen patients (52%, 95% confidence interval [47.1% − 56.9%]) received appropriate prophylactic agents out of 415 patients who were eligible for prophylaxis according to the ACCP 2016 guidelines. On the other hand, 199 (72.1%, 95% confidence interval [66.4% – 77.3%) patients received prophylaxis out of 276 ineligible patients.. The rate of compliance to guidelines showed wide variations according to the type of hospital, specialty, and the patients’ age. The multivariate logistic regression analysis showed that only age was a significant predictor of appropriate VTE prophylaxis (odds ratio [OR] 1.05, P < 0.001). Conclusion The rates of the appropriate use of VTE prophylaxis are low in Lebanon and Jordan. There is a lack of compliance to guidelines for VTE prophylaxis use for hospitalized patients in both countries.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

A Cross-sectional, Multicenter, Observational Study to Assess the Prophylaxis of Venous Thromboembolism in Lebanese and Jordanian Hospitals

Elgebaly

Masri

Bashaireh

et al. 2020

Preprint

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“…[6][7][8] Without routine use of risk prediction tools, pharmacologic VTE prophylaxis is either under-or overprescribed in medically ill hospitalized patients. [9][10][11] The PPS is calculated based on 11 clinical criteria that are weighed and summed to a score that stratifies patients as either high or low risk for VTE occurrence. 8 To use PPS, a clinician can use an online calculator for computation but must input a response for each individual clinical criteria.…”

Section: Introductionmentioning

confidence: 99%

Automated versus Manual Data Extraction of the Padua Prediction Score for Venous Thromboembolism Risk in Hospitalized Older Adults

et al. 2018

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Objective Venous thromboembolism (VTE) prophylaxis is an important consideration for hospitalized older adults, and the Padua Prediction Score (PPS) is a risk prediction tool used to prioritize patient selection. We developed an automated PPS (APPS) algorithm using electronic health record (EHR) data. This study examines the accuracy of APPS and its individual components versus manual data extraction. Methods This is a retrospective cohort study of hospitalized general internal medicine patients, aged 70 and over. Fourteen clinical variables were collected to determine their PPS; APPS used EHR data exports from health system databases, and a trained abstractor performed manual chart abstractions. We calculated sensitivity and specificity of the APPS, using manual PPS as the gold standard for classifying risk category (low vs. high). We also examined performance characteristics of the APPS for individual variables. Results PPS was calculated by both methods on 311 individuals. The mean PPS was 3.6 (standard deviation, 1.8) for manual abstraction and 2.8 (1.4) for APPS. In detecting patients at high risk for VTE, the sensitivity and specificity of the APPS algorithm were 46 and 94%, respectively. The sensitivity for APPS was poor (range: 6–34%) for detecting acute conditions (i.e., acute myocardial infarction), moderate (range: 52–74%) for chronic conditions (i.e., heart failure), and excellent (range: 94–98%) for conditions of obesity and restricted mobility. Specificity of the automated extraction method for each PPS variable was > 87%. Conclusion APPS as a stand-alone tool was suboptimal for classifying risk of VTE occurrence. The APPS accurately identified high risk patients (true positives), but lower scores were considered indeterminate.

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“…Although the underutilization of VTE prophylaxis in at-risk patients represents a major cause of inhospital mortality and morbidity, inappropriate use of VTE prophylaxis in low-risk patients, when not medically indicated, can have a negative impact on patients' outcomes leading to bleeding and drugs interaction (28). In the present study, we found that 77.97% of the medical patients, who were not eligible for VTE prophylaxis, received prophylactic agents, compared to 66.88% of the surgical patients who were not eligible for VTE prophylaxis.…”

Section: Discussionmentioning

confidence: 99%

“…reported that 77.9% of hospitalized patients received excessive VTE prophylaxis without appropriate indication (29). Another retrospective cohort study reported that pharmacological VTE prophylaxis was present in 74% of low-risk patients, who were not eligible for prophylaxis (28).…”

Section: Discussionmentioning

confidence: 99%

A Cross-sectional, Multicenter, Observational Study to Assess the Prophylaxis of Venous Thromboembolism in Lebanese and Jordanian Hospitals

Elgebaly

Masri

Bashaireh

et al. 2020

Preprint

View full text Add to dashboard Cite

Background There is a growing body of evidence showing substantial underuse of appropriate venous thromboembolism (VTE) prophylaxis in patients at risk. In the present study, our goal was to assess the current practices in the use rate of VTE prophylaxis among hospitalized patients in Jordan and Lebanon.Methods A cross-sectional, multicenter, observational study was conducted on 40 centers across Lebanon and Jordan. We included patients who were admitted to the participating hospitals for the treatment of a serious medical or surgical illness. The patients’ records were screened for the fulfillment of inclusion/exclusion criteria during a single assessment visit. The proportion of medical and surgical patients who were at risk of VTE and the thrombo-prophylactic measures employed by physicians for these patients were assessed according to the American College of Chest Physicians (ACCP 2016) guidelines. Results The present study included 704 patients (400 from Jordan and 304 from Lebanon) with a mean age of 54.9 ±17.5 years. Almost 59% of the patients received prophylaxis treatment in form of pharmacological anticoagulant prophylaxis and/or mechanical prophylaxis. Low molecular weight heparin was the most commonly used anticoagulant for VTE prophylaxis in 366 out of the total 704 (51.9%) patients in the analysis cohort. Two hundred and sixteen patients (52 %, 95% confidence interval [47.1% - 56.9%]) received appropriate prophylactic agents out of 415 patients who were eligible for prophylaxis according to the ACCP 2016 guidelines. On the other hand, 199 (72.1%, 95% confidence interval [66.4% – 77.3%) patients received prophylaxis out of 276 ineligible patients.. The rate of compliance to guidelines showed wide variations according to the type of hospital, specialty, and the patients’ age. The multivariate logistic regression analysis showed that only age was a significant predictor of appropriate VTE prophylaxis (odds ratio [OR] 1.05, P <0.001).Conclusion The rates of the appropriate use of VTE prophylaxis are low in Lebanon and Jordan. There is a lack of compliance to guidelines for VTE prophylaxis use for hospitalized patients in both countries.

show abstract

Poor Adherence to Risk Stratification Guidelines Results in Overuse of Venous Thromboembolism Prophylaxis in Hospitalized Older Adults

Cited by 17 publications

References 11 publications

A Cross-sectional, Multicenter, Observational Study to Assess the Prophylaxis of Venous Thromboembolism in Lebanese and Jordanian Hospitals

A Cross-sectional, Multicenter, Observational Study to Assess the Prophylaxis of Venous Thromboembolism in Lebanese and Jordanian Hospitals

Automated versus Manual Data Extraction of the Padua Prediction Score for Venous Thromboembolism Risk in Hospitalized Older Adults

A Cross-sectional, Multicenter, Observational Study to Assess the Prophylaxis of Venous Thromboembolism in Lebanese and Jordanian Hospitals

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