Factors associated with venous thromboembolism pharmacoprophylaxis initiation in hospitalized medical patients: the Medical Inpatients Thrombosis and Hemostasis study

Allen B Repp; Andrew D Sparks; Katherine Wilkinson; Nicholas S Roetker; Jordan K Schaefer; Ang Li; Leslie A McClure; Deirdra R Terrell; Augusto Ferraris; Alys Adamski; Nicholas L Smith; Neil A Zakai

doi:10.1016/j.jtha.2024.08.016

Factors associated with venous thromboembolism pharmacoprophylaxis initiation in hospitalized medical patients: the Medical Inpatients Thrombosis and Hemostasis study

J Thromb Haemost. 2024 Sep 12:S1538-7836(24)00502-6. doi: 10.1016/j.jtha.2024.08.016. Online ahead of print.

Authors

Affiliations

¹ Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA; Department of Medicine, University of Vermont Medical Center, Burlington, Vermont, USA. Electronic address: allen.repp@uvmhealth.org.
² Department of Medical Biostatistics, University of Vermont, Burlington, Vermont, USA.
³ Department of Pathology & Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA.
⁴ Department of Medicine, Hennepin Healthcare & Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA.
⁵ Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, Michigan, USA.
⁶ Section of Hematology-Oncology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
⁷ Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA; Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, St Louis, Missouri, USA.
⁸ Department of Biostatistics & Epidemiology, Hudson College of Public Health, Oklahoma City, Oklahoma, USA.
⁹ Department of Epidemiology, University of Washington, Seattle, Washington, USA.
¹⁰ Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
¹¹ Department of Epidemiology, University of Washington, Seattle, Washington, USA; Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs, Office of Research and Development, Seattle, Washington, USA.
¹² Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA; Department of Medicine, University of Vermont Medical Center, Burlington, Vermont, USA; Department of Pathology & Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA.

PMID: 39260742
DOI: 10.1016/j.jtha.2024.08.016

Abstract

Background: Although guidelines recommend risk assessment for hospital-acquired venous thromboembolism (HA-VTE) to inform prophylaxis decisions, studies demonstrate inappropriate utilization of pharmacoprophylaxis in hospitalized medical patients. Predictors of pharmacoprophylaxis initiation in medical inpatients remain largely unknown.

Objectives: To determine factors associated with HA-VTE pharmacoprophylaxis initiation in adults hospitalized on medical services.

Methods: We performed a cohort study using electronic health record data from adult patients hospitalized on medical services at 4 academic medical centers between 2016 and 2019. Main measures were candidate predictors of HA-VTE pharmacoprophylaxis initiation, including known HA-VTE risk factors, predicted HA-VTE risk, and bleeding diagnoses present on admission.

Results: Among 111 550 admissions not on intermediate or full-dose anticoagulation, 48 520 (43.5%) received HA-VTE pharmacoprophylaxis on the day of or the day after admission. After adjustment for age, sex, race/ethnicity, and study site, the strongest clinical predictors of HA-VTE pharmacoprophylaxis initiation were malnutrition and chronic obstructive pulmonary disease. Thrombocytopenia and history of gastrointestinal bleeding were associated with decreased odds of HA-VTE pharmacoprophylaxis initiation. Patients in the highest 2 tertiles of predicted HA-VTE risk were less likely to receive HA-VTE pharmacoprophylaxis than patients in the lowest (first) tertile (OR, 0.84; 95% CI, 0.81-0.86 for the second tertile; OR, 0.95; 95% CI, 0.92-0.98 for the third tertile).

Conclusion: Among patients not already receiving anticoagulants, HA-VTE pharmacoprophylaxis initiation during the first 2 hospital days was lower in patients with a higher predicted HA-VTE risk and those with risk factors for bleeding. Reasons for not initiating pharmacoprophylaxis in those with a higher predicted HA-VTE risk could not be assessed.

Keywords: anticoagulants; healthcare disparities; hospitalization; risk factors; venous thromboembolism.