Assessing Adherence to the ACCP Recommendations for Thromboprophylaxis in Hospitalized Medical and Surgical Patients

Background:

This study evaluated whether clinicians are providing appropriate thromboprophylaxis to at‐risk medical and surgical patients in accordance with ACCP guidelines.

Methods:

Premier's Perspective™ inpatient administrative database was used to assess VTE prophylaxis rates in acute medical (acute myocardial infarction [AMI], lung disease, stroke, heart failure, cancer, spinal cord injury, trauma) and surgical (orthopedic, urologic, gynecologic, neurological) patients. Only patients age 40 or older with a minimum length of stay of 6 days and no contraindications for anticoagulation were included in the study.

Two rates were determined — the rate of discharges receiving any level of anticoagulation and the rate of patients receiving appropriate prophylaxis — by comparing daily use of anticoagulants and compression devices, dosage of anticoagulants, and prophylaxis duration with the ACCP recommendations. The 6th guidelines were used because they were released prior to the study period. VTE prophylaxis rates based on the 7th guidelines were also calculated for the same patient cohort to assess how the revised guidelines affected our findings. Rates were assessed across geographic region, hospital demographics, and attending physician specialty. Trends were assessed by comparing prophylaxis rates for each discharge quarter.

Results:

The study included 196,104 medical and 85,970 surgical discharges from 227 hospitals from January 2002 through September 2003. Appropriate VTE prophylaxis rates varied significantly across diagnostic and surgical groups. Among medical groups, the rates were 49% for ischemic stroke, 43% for AM), 40% for heart failure, 31% for severe lung disease, 27% for cancer, 22% for nonsurgical acute spinal cord injury, and 20% for nonsurgical trauma patients. Among surgical groups, the rates were 74% for orthopedic, 31% for general, 26% for urologic, 24% for gynecologic, and 12% for neurological surgery patients.

On average, 33% of all at‐risk medical and surgical discharges received ACCP‐compliant VTE prophylaxis. Of the remaining, 46% received no prophylaxis, and 21% did not receive prophylaxis for the recommended duration. Regional variation was evident, ranging from 28% in the New England and west north central regions to 40% in the mid‐Atlantic region. Appropriate prophylaxis rates based on the 7th guidelines were lower than the rates based on the 6th guidelines because the 7th guidelines recommendations are more specific.

Conclusions:

At‐risk medical and surgical patients are known to have significant risk for VTE, yet VTE prophylaxis for medical inpatients is not optimal. Rates for surgical patients were only slightly higher. More effort is required to increase awareness of the ACCP recommendations for thromboprophylaxis in at‐risk patients.

Author Disclosure:

A. N. Amin, sanofi‐aventis, speakers bureau; Pfizer, speakers bureau; GSK, speakers bureau; S. A. Stemkowski, Premier, employment (full‐ or part‐time); J. Lin, sanofi‐aventis, employment (full‐ or part‐time); G. Yang, Premier, employment (full‐ or part‐time).