Details:

• Alternative Title:
  J Thromb Haemost
• Personal Author:
  Repp, Allen B. ; Sparks, Andrew D. ; Wilkinson, Katherine ; Roetker, Nicholas S. ; Schaefer, Jordan K. ; ... More +

  Repp, Allen B. ; Sparks, Andrew D. ; Wilkinson, Katherine ; Roetker, Nicholas S. ; Schaefer, Jordan K. ; Li, Ang ; McClure, Leslie A. ; Terrell, Deirdra R. ; Ferraris, Augusto ; Adamski, Alys ; Smith, Nicholas L. ; Zakai, Neil A. Less -
• Description:
  Background:
  
  Although guidelines recommend risk assessment for hospital-acquired venous thromboembolism (HA-VTE) to inform prophylaxis decisions, studies demonstrate inappropriate utilization of pharmacoprophylaxis in hospitalized medical patients. Predictors of pharmacoprophylaxis initiation in medical inpatients remain largely unknown.
  
  Objective:
  
  To determine factors associated with HA-VTE pharmacoprophylaxis initiation in adults hospitalized on medical services.
  
  Design:
  
  Cohort study using electronic health record data from adult patients hospitalized on medical services at four academic medical centers between 2016 and 2019.
  
  Participants:
  
  Among 111,550 admissions not on intermediate or full-dose anticoagulation, 48,520 (43.5%) received HA-VTE pharmacoprophylaxis on the day of or the day after admission.
  
  Main Measures:
  
  Candidate predictors of HA-VTE pharmacoprophylaxis initiation, including known HA-VTE risk factors, predicted HA-VTE risk, and bleeding diagnoses present on admission.
  
  Key Results:
  
  After adjustment for age, sex, race/ethnicity, and study site, the strongest clinical predictors of HA-VTE pharmacoprophylaxis initiation were malnutrition and chronic obstructive pulmonary disease. Thrombocytopenia and history of gastrointestinal bleeding were associated with decreased odds of HA-VTE pharmacoprophylaxis initiation. Patients in the highest two tertiles of predicted HA-VTE risk were less likely to receive HA-VTE pharmacoprophylaxis than patients in the lowest (1st) tertile (OR 0.84, 95% CI [0.81, 0.86] for 2nd tertile, OR 0.95, 95% CI [0.92, 0.98] for 3rd tertile).
  
  Conclusions:
  
  Among patients not already receiving anticoagulants, HA-VTE pharmacoprophylaxis initiation during the first two hospital days was lower in patients with higher predicted HA-VTE risk and those with risk factors for bleeding. Reasons for not initiating pharmacoprophylaxis in those with higher predicted risk could not be assessed.
  
  
• Subjects:
  [+]

  Academic Medical Centers Adult Aged Aged, 80 And Over Anticoagulants Electronic Health Records Female Hemorrhage Hemostasis Hospitalization Humans Inpatients Male Middle Aged Risk Assessment Risk Factors United States Venous Thromboembolism
• Keywords:
  [+]

  Anticoagulants / Therapeutic Use Healthcare Disparities Venous Thromboembolism / Prevention & Control
• Source:
  J Thromb Haemost. 22(12):3521-3531
• Pubmed ID:
  39260742
• Pubmed Central ID:
  PMC11608142
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/ ; R01 HL141290/HL/NHLBI NIH HHSUnited States/

  CC999999/ImCDC/Intramural CDC HHSUnited States/ ; R01 HL141290/HL/NHLBI NIH HHSUnited States/ Less -
• Volume:
  22
• Issue:
  12
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  [+]

  urn:sha-512:3b05865a265c3d3a0811b87bd1df720f8bda417dbcbedb7ae8a860376d73048a8a144ba6f4481f33d710bd0a599dbc70511402b35dab612ab7f65fd39ea15ac1
• File Type:

• Supporting Files:
  No Additional Files