Author + information
- Rahul Chaudhary,
- Martin Sanchez,
- Bhavina Batukbhai,
- Malini Chandra Serharan,
- Eric Feng,
- Charles R. Albrecht III and
- Mauro Moscucci
Background: Guidelines for venous thromboembolism (VTE) prophylaxis recommend stratification as high or low risk followed by institution of chemical or mechanical prophylaxis respectively. We explored adherence to current guidelines based on presence of VTE prophylaxis documentation.
Methods: Retrospective chart review of 437 consecutive patients admitted to general medical floors from 01/01/2015 to 03/01/2015. Patient's risk for VTE was calculated using the Padua prediction score and compared to documented risk in the electronic medical records (EMR). The type of prophylaxis (chemical vs. mechanical) was compared between documented and calculated risk and a cost-benefit analysis performed.
Results: Appropriate stratification based on comparison of documented with calculated risk was observed in 54.5% of patients (41% with low risk vs. 71.7% with high-risk, p=0.007). 189/239 patients (79%) with a calculated low risk, received potentially unnecessary chemical prophylaxis while 13/198 patients at high risk and without contraindications for chemical prophylaxis received mechanical or no prophylaxis (11 and 2 patients respectively). No clinical VTE events were noted in this small group of patients inappropriately assigned to mechanical or no prophylaxis. In addition, 71/92 (78%) of patients with both low estimated and low calculated risk and 44/51 (86%) patients with low estimated and high calculated risk received chemical prophylaxis, consistent with a tendency towards over-treatment. A total of 1017 patient-days of inappropriate chemical prophylaxis worth $19,413 were administered over 3 months, which was in addition to patient discomfort from injections.
Conclusions: 1) Subjective estimation of patients’ risk for VTE tends to be inaccurate when compared to the risk calculated using risk prediction models, and it might be associated with unnecessary over-treatment of patients. 2) These data further support the inclusion of VTE risk calculators in EMR.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Diabetes and Other Issues in Cardiovascular Prevention
Abstract Category: 32. Prevention: Clinical
Presentation Number: 1277-057
- 2017 American College of Cardiology Foundation