Why the study?
Little is known about current prescription practice for VTE prophylaxis in medical inpatients and whether differences exist between subspecialties such as cardiology and gastroenterology.
Does the rate of risk-based VTE prophylaxis differ between cardiology and gastroenterology inpatients?
Does the rate of risk-based VTE prophylaxis differ between cardiology and gastroenterology inpatients?
Inpatient VTE prophylaxis is often driven by length of stay rather than objective risk scores, with low-risk cardiology patients more likely to receive potentially unnecessary prophylaxis than gastroenterology patients.
BACKGROUND: Current guidelines recommend risk-based use of prophylaxis for preventing medical inpatients from venous thromboembolism (VTE). Little is known about the current prescription practice, and even less whether differences between subspecialists like cardiologists, usually treating patients with thrombotic or thromboembolic diseases, and gastroenterologists, treating more patients with gastrointestinal bleeding complications, exist. METHODS: We performed a retrospective chart review of patients on cardiology and gastroenterology wards of our university hospital. Patients with a clear indication for anticoagulation and contraindication against antithrombotic treatment were excluded. A total of 450 patients per specialty were included. Quantitative risk assessment models were used to determine the risk of a VTE (Padua Prediction Score (PPS), IMPROVE Score) and bleeding (IMPROVE-Bleeding and HAS-BLED Score). RESULTS: The overall rate of VTE prophylaxis was high in both patient populations. Significant more low-risk cardiology compared to gastroenterology patients received drug-based prophylaxis. Furthermore, crucial discrepancies were found in the way individual patients would be classified based on PPS and IMPROVE Score. Finally, not the risk category but the length of hospital stay was best at predicting which patient received prophylaxis.
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Nemani et al. (2021) studied this question.
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