Thromboprophylaxis use in medical inpatients and the impact of electronic risk assessment tool
Authors: Mukhi Nikhil , Sidhu Gurinder , Nabors Christopher , Iragavarapu Chaitanya 
Published: November 2019

Introduction:

VTE is the third most common cause of hospital related deaths and the most common preventable cause of hospital death. Population based studies have continually emphasized the rising prevalence of VTE. As per data from CDC, VTE complicated about 550,000 hospitalizations each year in adults >18yrs. The prevalence was much higher in adults >60yrs and female sex. Pulmonary embolism accounts for about 5-10% of hospital deaths and the case fatality rates of DVT ranges between 1-10% mainly due to fatal PE and is highest in those with malignancies. VTE is associated with long term risks of post thrombotic syndrome and chronic thromboembolic pulmonary hypertension which contributes significantly to patient morbidity and cost of management.

The ENDORSE trial assessed the proportion of at-risk medical patients who received thromboprophylaxis and determined that 39.5% (6119 out of 15487 patients) received ACCP-recommended VTE prophylaxis. The most effective strategies to improve prophylaxis consist of a system for reminding clinicians to assess patients for VTE risk, either electronic decision-support systems or paper-based reminders. In a recent study electronic VTE risk assessment tool (elVis) on VTE prophylaxis in hospitalised patients improved the prophylaxis rates by 5.0% amongst all patients and by 10.7% amongst high risk patients.

Materials and Methods:

This was a retrospective study to assess the effectiveness of a VTE (Venous Thrombo Embolism) risk assessment tool as part of the in hospital quality control initiative. A total of 400 charts were reviewed; 200 prior to implementation of the risk assessment tool, and 200 after. Patients with incomplete or missing data were excluded. A total of 388 patients were included in the study (Fig 1). These patients were randomly picked in the pre and post implementation phases of the study (April 2011 and October 2011 respectively). The hospital committee designed the risk assessment tool based on the ACCP guidelines with few modifications individualized to our patient population.

The tool was an automatic and mandatory pop op that would guide the admitting resident in making a decision about VTE prophylaxis. After the tool was implemented (July 2011), all house staff were educated on its use by a dedicated lecture during a noon conference session.

Results:

Demographics and results of the study are shown via the following table: Table 1.Pre-VTE toolPost-VTE toolNumber of patients189199Male47.9%49.7%Moderate –High Risk57.1%61.3%Individual Risk FactorsPrior VTE13.7%15.7%Chronic Pulm Disease17.9%19.1%Chronic Heart Failure14.4%16.9%Long term immobility11.7%17.4%Obesity37.2%34.3%Thrombophilia1.2%1.1%Malignancy4.6%4.7%Contraindications to anticoagulation19.04%19.06%Treatment Correctness56.3%80.3%

Conclusions:

This study gives us insight that VTE risk assessment tool accompanied with staff education improves VTE prophylaxis in at risk medicine inpatients. Study also confirms that incorporation of VTE prophylaxis guidelines in routine clinical practice can be assisted by electronic assessment and decision support tools.

Disclosures

No relevant conflicts of interest to declare.