Background: Medical patients can be risk stratified using the Padua Prediction Score for venous thromboembolism (vte). It is important to then use the appropriate prophylaxis, chemical, mechanical or none. Studies have not found an added mortality benefit by combining chemical and mechanical prophylaxis. Inappropriate prophylaxis places patients at risk for adverse events like bleeding, risk of heparin induced thrombocytopenia, discomfort, falls, delay in mobilization, increased healthcare costs, decreased patient satisfaction, and vte.
Methods: This study assessed how many patients were appropriately risk stratified using Padua and started on inappropriate prophylaxis compared to appropriate prophylaxis. A retrospective chart review was completed of hospitalized patients from January to June 2018. Each patient was risk stratified into low or moderate/ high risk. The latter group was further analyzed to see if there was a contraindication to chemical prophylaxis. Each patient chart was reviewed to see what prophylaxis was ordered.
Results: There were 14 of 136 low risk, 9 received mechanical and 4 received chemical prophylaxis. 122 of 136 were moderate/high risk. 108/122 had no contraindication to chemical prophylaxis, 71 received chemical, 11 received mechanical, 16 received both and 10 received none. 14/122 had a contraindication of which 8 received mechanical and 6 received chemical.
Conclusions: Study found 41 percent of our patients were not given the appropriate prophylaxis based on risk stratification using Padua. It will be important to launch an intervention emphasizing the use of Padua to risk stratify patients as well as focusing on the indications for chemical versus mechanical versus no prophylaxis.