Background: Hospital-associated venous thromboembolism (HA-VTE) is a serious condition with controversy regarding ideal risk assessment and VTE prophylaxis (VTEP), especially in medical patients. We conducted a collaborative VTE quality improvement project, supported by a charitable grant from the Gordon and Betty Moore Foundation, in 35 hospitals across three states and assessed the impact on HA-VTE [...]

Background: Hospital-associated venous thromboembolism (HA-VTE) is a serious condition with controversy regarding ideal risk assessment and VTE prophylaxis (VTEP), especially in medical patients. We conducted a collaborative VTE quality improvement project, supported by a charitable grant from the Gordon and Betty Moore Foundation, in 35 hospitals across three states and assessed the impact on HA-VTE [...]

Background: Peripherally inserted central catheters (PICCs) are becoming increasingly popular due to their ease of insertion through upper extremity veins, although they are not complications-free. PICCs can be irritating and cause endothelial injury and inflammation resulting in venous thrombosis. Estimates suggest that more than a third of all deep venous thrombosis (DVT) in the upper [...]

Background: Multiple factors can lead to overuse of diagnostic imaging for venous thromboembolism (VTE). These include fear of missing a potentially fatal diagnosis, low predictive accuracy of clinical gestalt, prediction rules, and risk assessment models for VTE, and increased access to imaging. Diagnostic imaging for deep venous thrombosis (DVT) with doppler ultrasonography, or for pulmonary [...]

Background: Venous thromboembolism (VTE) in hospitalized medically ill patients is a leading preventable cause of morbidity and mortality in the United States. About half of VTE events occur following discontinuation of standard-duration in-hospital prophylaxis and hospital discharge. The APEX study evaluated Betrixaban for in-hospital to home VTE prophylaxis and is the first FDA approved anticoagulant [...]

Background: Venous thromboembolism (VTE) in hospitalized medically ill patients is a leading preventable cause of morbidity and mortality in the United States. About half of VTE events occur following discontinuation of standard-duration in-hospital prophylaxis and hospital discharge. The APEX study evaluated Betrixaban for in-hospital to home VTE prophylaxis and is the first FDA approved anticoagulant [...]

Background: The Michigan PICC-DVT Risk Score (MRS) identified five predictors for deep venous thrombosis (DVT) associated with peripherally inserted central catheters (PICCs): presence of another central venous catheter (CVC) when device is placed, white blood cell (WBC) count at time of insertion, active cancer, number of catheter lumens, and history of venous thromboembolism (VTE)1. We [...]

Background: Peripherally inserted central catheters (PICCs) are frequently used to deliver intravenous (IV) antibiotic therapy. Infectious disease (ID) physicians are often consulted prior to PICC placement, but whether their engagement influences PICC appropriateness and complications is not known. Methods: Using data from the Michigan Hospital Medicine Safety Consortium on PICCs placed in hospitalized medical patients [...]

Background: Until the advent of novel oral anticoagulants (NOACs), Warfarin was the only oral agent available for the treatment of deep venous thrombosis (DVT) and Pulmonary embolism (PE). Bridging with parenteral anticoagulation until warfarin reaches a full therapeutic level often results in prolonged hospitalization. Rivaroxaban, Dabigatran, Apixaban, Edoxaban were approved by the FDA for DVT [...]

Background: The venous thromboembolism (VTE) rate in patients with current or recent hospitalization is 330/100,000 person-year vs. 8/100,000 in outpatients. Hence, hospitalists often assess risk and pursue a diagnosis of VTE in their patients. Lower extremity (LE) DVT risk prediction tools such as the Wells score perform poorly on inpatients and hospitalist specific guidelines for [...]