Venous thromboembolism (VTE) represents a major public health problem in Australia and worldwide, contributing to hundreds of thousands of deaths each year.
To assess adherence to recommended guidelines in a range of clinical settings.
Retrospective, observational study of 955 medical (M), surgical (S) and orthopaedic (O) patient charts of all M, S and O patients admitted during March 2011. Patients on warfarin were excluded from the analysis. Appropriate or inappropriate prophylaxis was assessed according to high, medium and low risk stratification. Patient risk stratification for VTE, suitability of prophylaxis given, adverse events and length of stay were recorded.
Nine hundred and thirteen eligible patients were assessed, 54% male, mean age 57 ± 21 years. Regarding the 372 M patients, 235 (63%) were on appropriate prophylaxis, compared with 84% (273/326) S and 78% (168/215) O patients (M to S, P < 0.0001; M to O, P = 0.0002; S to O, P = 0.113). High risk prevalence was 56% in M, 9% in S and 12% in O patients (P < 0.0001). Nine confirmed or possible VTE events occurred (seven M, with five of these on inappropriate prophylaxis). All three bleeding events (one fatal) were in M patients, two of whom had appropriate prophylaxis. Average length of stay was 4.1 ± 5.0, 2.1 ± 3.3 and 2.1 ± 3.8 days (P < 0.001) for M, S and O patients respectively.
Better adherence to prophylaxis guidelines is required, especially in M patients where the prevalence of high-risk VTE is greater.