Norra MacReady

April 07, 2008

April 7, 2008 (San Diego) — Rates of venous thromboembolism (VTE) dropped significantly at a large university medical center thanks to a new protocol that identifies high-risk patients, according to findings presented here at Hospital Medicine 2008, the annual meeting of the Society of Hospital Medicine.

Hospital-acquired VTE (HAVTE) is "probably the number 1 cause of preventable hospital-associated death," lead investigator Greg Maynard, MD, clinical professor of medicine at the University of California, San Diego (UCSD), told Medscape Internal Medicine. "It causes more deaths than HIV, motor vehicle accidents, and breast cancer combined."

HAVTE results from a constellation of issues, said Dr. Maynard. Severely ill hospital patients usually have multiple risk factors for VTE, overworked hospital staff may forget about it as they address more urgent tasks, and clinicians tend to emphasize bleeding prevention over VTE prophylaxis, despite the fact that "the risk of a clot is logarithmically higher than the risk of bleeding."

The protocol consists of a computer-guided assessment that classifies patients as low, moderate, or high risk on the basis of factors such as age, procedure, comorbidities, ambulation status, and the presence of contraindications to prophylactic treatment, said coauthor Ian Jenkins, MD, associate clinical professor of medicine at UCSD.

The investigators tested the protocol and gathered consensus on it from mid-2005 to mid-2006, with further refinements made in the first half of 2007. Real-time intervention began in the second half of 2007. The percentage of patients on adequate prophylaxis rose from 67% in 2005 to 76% in 2006, and to 92% in 2007 (P < .001), reaching 98% in the final months of 2007.

The rate of HAVTE went from about 130 in about 9800 at-risk patients in 2005 to 2006 to 82 in about 10,600 patients in 2007, Dr. Jenkins said. The incidence of hospital-acquired pulmonary emboli went from about 30 in 2005 to 2006 to 13 in 2007. Rates of deep venous thrombi dropped from an average of 148 in 2005 to 2006 to 93 in 2007 (P < .05 for both).

All in all, "about 50 people per year can expect not to get VTE due to this protocol," Dr. Jenkins said.

HAVTE is a serious problem among hospitalized patients, agreed Moira L. Ogden, MD, a hospitalist at Terrebonne Medical Center in Houma, Louisiana, who was not involved in the study. A protocol like this "will be of clinical value because we must take a leadership role in the implementation of protocols that help decrease the morbidity associated with medical conditions."

Dr. Maynard receives speaking honoraria from Sanofi-Aventis; Dr. Jenkins has disclosed no relevant financial relationships.

Hospital Medicine 2008: Abstract 52. Presented April 4, 2008.

J Hosp Med. 2008;3(suppl 1):29.

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