Key result
Real-world thromboprophylaxis use exceeds IMPROVE-guided criteria by ~33 percentage points.
Why the study?
Venous thromboembolism is a major preventable cause of morbidity and mortality in hospitalized medical patients, and the discrepancy between real-world thromboprophylaxis prescribing and IMPROVE-based risk assessment strategies is unclear.
Does a prespecified sequential IMPROVE-based strategy reduce unnecessary thromboprophylaxis prescribing, costs, and carbon emissions compared to real-world practice in medical inpatients?
Cohort (n=99)
No
Does a prespecified sequential IMPROVE-based strategy reduce unnecessary thromboprophylaxis prescribing, costs, and carbon emissions compared to real-world practice in medical inpatients?
Absolute Event Rate: 79.8% vs 46.5%
Applying sequential IMPROVE risk assessment models for VTE prophylaxis in medical inpatients could safely reduce overtreatment, healthcare costs, and environmental impact, highlighting a gap in real-world prescribing.
Real-world thromboprophylaxis prescribing exceeded IMPROVE criteria; hypothesis-generating for prospective trials before any practice change.
Background Venous thromboembolism (VTE) is a major preventable cause of morbidity and mortality in hospitalized medical patients. Current recommendations support broad pharmacologic thromboprophylaxis, while individualized risk assessment may help refine prescribing. The IMPROVE VTE and IMPROVE Bleeding scores provide standardized risk assessment tools but should complement, rather than replace, clinical judgment. Objective To evaluate the discrepancy between real-world thromboprophylaxis prescribing and a prespecified sequential IMPROVE-based strategy and assess its economic and environmental implications. Methods We conducted a single-center retrospective cohort study in internal medicine over one month. Adults hospitalized for > 48 h were included, excluding those receiving therapeutic anticoagulation. IMPROVE VTE and Bleeding scores were calculated retrospectively. Pharmacologic prophylaxis was supported by the strategy for patients with an IMPROVE Bleeding score < 7 and IMPROVE VTE score ≥ 2. Observed prescriptions were compared with the prespecified strategy using contingency analysis and Fisher's exact test. Results Among 99 patients, 79.8% received pharmacologic thromboprophylaxis, whereas 46.5% met the strategy criteria. Among treated patients, 46.8% did not meet these criteria. Strict application of the strategy would theoretically result in 292 fewer doses over one month, corresponding to €233.60 in estimated savings and approximately 405 kg CO 2 eq. Conclusion Real-world prescribing differed substantially from the prespecified strategy. Strict application would theoretically reduce anticoagulant use, costs, and carbon emissions. However, clinical outcomes were not assessed, and RAMs should complement rather than replace clinical judgment. Prospective studies incorporating VTE and bleeding outcomes are required to assess the safety of this approach.
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Bourny et al. (2026) conducted a cohort in Venous thromboembolism prevention (n=99). Real-world thromboprophylaxis prescribing vs. Prespecified sequential IMPROVE-based strategy was evaluated on Discrepancy in thromboprophylaxis indication. Real-world pharmacologic thromboprophylaxis was prescribed to 79.8% of patients, whereas only 46.5% met the criteria for a prespecified sequential IMPROVE-based strategy.
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