Abstract 13287: Inadequacy of Current Deep Venous Thrombosis Prophylaxis in Medical Inpatients with a Prior History of Venous Thromboembolism
Background: In-hospital venous thromboembolism (VTE) such as pulmonary embolism (PE) and deep venous thrombosis (DVT) remains the most common preventable cause of hospital death in the U.S. However, only half of VTE are prevented by recommended prophylaxis. Accordingly, we aimed to identify which risk factors, if any, remain significant in medically hospitalized patients who are already on recommended pharmacological prophylaxis.
Methods: Demographic data and risk factors for VTE as shown in the Table were retrospectively obtained from charts of 10,633 patients who were admitted to the medicine service from June 2007 to May 2009 and who received recommended prophylaxis with subcutaneous unfractionated heparin. Patients with recent surgery, pregnancy, discharge within 24 hours, or those receiving therapeutic anticoagulation were excluded. The diagnoses of PE and DVT were confirmed with CT angiography and Doppler ultrasound, respectively. Univariate analysis with the chi-square test followed by log-linear Poisson regression analysis was performed to determine relative risk associated with each factor.
Results: Sixty cases (43 cases of DVT and 26 cases of PE, including 9 cases with both DVT and PE) were observed during the study period (raw incidence, 0.6%; 95% CI [0.43–0.72]). Among the risk factors, only a previous history of VTE remained a significant risk with both univariate and multivariate analyses (relative risk=30.1; 95% CI [17.1–53.0]; p<0.0001). Patients with active malignancy had a marginal trend towards increased risk (relative risk=1.87; 95% CI [0.95–3.65]; p=0.07).
Conclusion: Hospitalized medical patients with a prior history of VTE remain at significant risk for recurrence of VTE even with the recommended prophylaxis. This suggests that patients with a prior history of VTE and possibly those with active malignancy may warrant closer observation and may benefit from more intense anticoagulation.
- © 2010 by American Heart Association, Inc.