Pharmacological Prophylaxis for Venous Thromboembolism Among Hospitalized Patients With Acute Medical Illness: An Electronic Medical Records Study

Marc Rosenman, Xianchen Liu, Hemant Phatak, Rong Qi, Evgenia Teal, Daniel Nisi, Larry Z. Liu, Eduardo Ramacciotti

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Patients hospitalized with acute medical illness have an elevated risk of venous thromboembolism (VTE). American College of Chest Physicians guidelines list various chronic illnesses, sepsis, advanced age, history of VTE, and immobility as risk factors and recommend prophylactic anticoagulation using fondaparinux, low–molecular weight heparin, or low-dose unfractionated heparin. The objectives of this study were to examine pharmacological prophylaxis against VTE among hospitalized medically ill patients and to assess demographic and clinical correlates related to VTE prophylaxis. A retrospective (1999–2010) electronic medical records study included patients aged 40 years and older hospitalized for at least 3 days, with significant medical illness or with a VTE hospitalization 30–365 days before admission. Each patientʼs first qualifying hospitalization was analyzed. Exclusions were if VTE treatment was started within 1 day of admission, or if warfarin (and not heparin or enoxaparin) was used. Prophylaxis was defined if the first inpatient dose of subcutaneous heparin or enoxaparin was at prophylaxis levels (lower than treatment levels). Multivariable logistic regression was used to examine factors associated with VTE prophylaxis. Among 12,980 patients, 22.1% received prophylaxis (11.8% with enoxaparin, 10.3% with heparin). VTE prophylaxis was positively associated with year of hospitalization, subcutaneous heparin in the month before admission, aspirin, self-pay status, age, and sepsis. VTE prophylaxis was negatively associated with smoking, alcohol, warfarin in the past 30 days, and primary diagnoses of stroke, infectious disease, or inflammatory bowel disease. Pharmacological VTE prophylaxis has increased significantly over the past 12 years but is still largely underused in patients hospitalized with acute medical illness. Multiple demographic, behavioral, and clinical factors are associated with inpatient VTE prophylaxis.

Original languageEnglish (US)
JournalAmerican Journal of Therapeutics
DOIs
StateAccepted/In press - Dec 29 2015

Fingerprint

Electronic Health Records
Venous Thromboembolism
Pharmacology
Heparin
Enoxaparin
Hospitalization
Inpatients
Sepsis
Demography
Warfarin
Inflammatory Bowel Diseases
Aspirin
Communicable Diseases
Chronic Disease
Logistic Models
Smoking
Stroke
Guidelines
Weights and Measures

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)

Cite this

Pharmacological Prophylaxis for Venous Thromboembolism Among Hospitalized Patients With Acute Medical Illness : An Electronic Medical Records Study. / Rosenman, Marc; Liu, Xianchen; Phatak, Hemant; Qi, Rong; Teal, Evgenia; Nisi, Daniel; Liu, Larry Z.; Ramacciotti, Eduardo.

In: American Journal of Therapeutics, 29.12.2015.

Research output: Contribution to journalArticle

Rosenman, Marc ; Liu, Xianchen ; Phatak, Hemant ; Qi, Rong ; Teal, Evgenia ; Nisi, Daniel ; Liu, Larry Z. ; Ramacciotti, Eduardo. / Pharmacological Prophylaxis for Venous Thromboembolism Among Hospitalized Patients With Acute Medical Illness : An Electronic Medical Records Study. In: American Journal of Therapeutics. 2015.
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