Cystic fibrosis (CF) and sickle cell disease (SCD) are associated with increased risk of venous thromboembolism (VTE), and this risk is exacerbated by hospitalization. VTE prophylaxis non-administration is a VTE risk factor. The objective of this study was to characterize VTE prophylaxis non-administration among patients with either CF or SCD compared to medically ill patients without CF or SCD. We conducted a single-center retrospective cohort study of hospitalized patients who were prescribed at least 2 doses of pharmacologic VTE prophylaxis. The primary outcome was the proportion of non-administered VTE prophylaxis doses by cohort. Multivariable logistic regression was used to identify characteristics associated with non-administration. A total of 13,316 patients were included; 89 with CF, 246 with SCD, and 12,981 other-medically ill. During the study period, 95,697 doses were prescribed; non-administration rates were 61.8% in the CF cohort, 32.7% in the SCD cohort, and 19.7% in the medically ill cohort (p0.01). In the multivariable logistic regression, CF or SCD diagnosis odds ratio (OR) 2.03, 95% confidence interval (CI) 1.59-2.6, multiple admissions (OR 2.4, 95% CI 2.19-2.64), and 5 prescribed doses of VTE prophylaxis (OR 2.48, 95% CI 2.29-2.69) were associated with non-administration of one or more doses. The percent of missed doses (median, IQR) per patient was highest in the CF cohort (66.7%, 84.5), followed by the SCD cohort (10.6%, 50), and medically ill cohort (0%, 16.7, p0.01). These findings suggest strategies to improve VTE prophylaxis administration rates during acute hospitalization in high-risk conditions such as CF and SCD are needed.
Caparon et al. (Tue,) studied this question.