Venous thromboembolism prophylaxis in hospitalized medical patients

Background: Venous thromboembolism (VTE) is the most common unpredictable cause of in-hospital death. Despite the fact that VTE prophylaxis has been proven to be efficacious and safe it remains underused. The aim is to determine the use of VTE prophylaxis in patients admitted to medical wards of the Division of Internal Medicine of the University Medical Centre Ljubljana. Methods: On a pre-specified day, all patients hospitalized on the wards of the Division of Internal Medicine were assessed for VTE risk by Padua prediction score. According to the risk of VTE and contraindications for pharmacological prophylaxis the adequacy of VTE prophylaxis was determined by trained data abstractors. Doctors responsible for the patients’ treatment were not aware of the study. Results: 511 patients were enrolled (222 women and 289 men). VTE prophylaxis was not indicated in 245 patients; 17 (6.9 %) patients classified as being at low risk for VTE nevertheless received prophylaxis. A half of 266 (52.1 %) patients at high risk for VTE had a contraindication to pharmacological prophylaxis. In 133 at-risk patients without contraindications, VTE prophylaxis was prescribed correctly in 50 (37.6 %) patients, 11 (8.3 %) patients received wrong doses and 72 (52 %) at-risk patients did not receive any prophylaxis. Conclusion: On the chosen day, VTE prophylaxis was appropriately used in 81 % of hospitalized patients on medical wards of the Division of Internal Medicine of the University Medical Centre Ljubljana. Since only 37 % of the patients at high risk for VTE received recommended VTE prophylaxis, our data reinforce the rationale to implement measures to improve these results