Optimizing VTE Prophylaxis in Inpatients

Educational Objectives

Summary

Optimizing VTE Prophylaxis in Hospitalized Patients

Many hospitals have implemented mechanisms to prevent hospital-acquired venous thromboembolism (VTE); however, some of those protocols have led to overtreatment of low-risk patients (https://www.jwatch.org/na57626 and J Hosp Med 2024; 19:449). Using American Society of Hematology guidelines (https://doi.org/10.1182/bloodadvances.2018022954) and decision analysis, investigators retrospectively applied risk prediction models for both VTE risk (IMPROVE VTE risk score https://www.mdcalc.com/calc/10349/improve-risk-score-venous-thromboembolism-vte) and bleeding risk (IMPROVE Bleeding risk score https://www.mdcalc.com/calc/10465/improve-bleeding-risk-score) to 2000 hospitalized medical patients in their South Carolina healthcare system during 1 year to determine which patients merited pharmacologic VTE prophylaxis to optimize outcomes. Details appear in Blood Advances (https://doi.org/10.1182/bloodadvances.2024013166).

Providing VTE prophylaxis to patients with IMPROVE VTE scores ≥2 and IMPROVE Bleeding scores ≤7 would have optimized prevention of VTE events while minimizing bleeding (compared with various other strategies). Using this methodology, 31% of low-risk patients who received pharmacologic VTE prophylaxis could have been spared that intervention. A smaller proportion of patients (13%) might have had pharmacologic prophylaxis withheld inappropriately, which also could have been remediated using this strategy.

Leveraging the electronic health record to estimate VTE and bleeding risks on admission could improve inpatient outcomes while lowering costs. The authors estimate that their healthcare system could save ≈US$5 million annually by applying this methodology. However, the devil might be in the details for implementing this type of information technology strategy across an organization. In the meantime, individual clinicians could use these or other risk scores, such as the Padua score (https://www.mdcalc.com/calc/2023/padua-prediction-score-risk-vte) to help determine when patients need pharmacologic VTE prophylaxis at admission.

Daniel D. Dressler, MD, MSc, MHM, FACP

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Disclosures

Acknowledgements

CME/CE INFO

Accreditation:

The Audio- Digest Foundation is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Audio- Digest Foundation designates this enduring material for a maximum of 0.00 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Audio Digest Foundation is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's (ANCC's) Commission on Accreditation. Audio Digest Foundation designates this activity for 0.00 CE contact hours.

Lecture ID:

JW351721

Expiration:

This CME course qualifies for AMA PRA Category 1 Credits™ for 3 years from the date of publication.

Instructions:

To earn CME/CE credit for this course, you must complete all the following components in the order recommended: (1) Review introductory course content, including Educational Objectives and Faculty/Planner Disclosures; (2) Listen to the audio program and review accompanying learning materials; (3) Complete posttest (only after completing Step 2) and earn a passing score of at least 80%. Taking the course Pretest and completing the Evaluation Survey are strongly recommended (but not mandatory) components of completing this CME/CE course.

Estimated time to complete this CME/CE course:

Approximately 2x the length of the recorded lecture to account for time spent studying accompanying learning materials and completing tests.

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