Venous thromboembolism prophylaxis in acutely ill hospitalized medical patients. A retrospective multicenter study

• Venous thromboembolism prophylaxis was reviewed in a multicenter retrospective study.
• Most of the symptomatic episodes develop in patients that received prophylaxis.
• Many high-risk patients for venous thromboembolism are also at risk for bleeding.
• Venous thromboembolism incidence was highest in patients at high-risk for bleeding.

ObjectiveTo analyze the incidence of VTE in hospitalized medical patients and prophylaxis applied in accordance with the 8th ACCP guidelines and the National PRETEMED guide for thromboprophylaxis.MethodsDischarge lists were reviewed to select the first consecutive 20 patients, aged ≥ 40 years and admitted ≥ 4 days to the Internal Medicine Departments of 79 Spanish hospitals. Exclusion criteria were: admission for diagnostic procedures, VTE or surgical illness, or care during hospitalization provided by the local investigator.ResultsFrom September 2011 to July 2012, 2845 discharge reports were evaluated and 1623 were considered eligible for the study. Overall 930 (57.3%) patients of this group were at risk of VTE according to the ACCP guidelines, 759 (81.6%) received VTE prophylaxis (mechanical or pharmacological) and 159 (17.1%) had at least one risk factor that might contraindicate anticoagulant use. The proportion of patients at VTE risk according to the ACCP and National PRETEMED guidelines with no risk factors of bleeding that did not receive prophylaxis was 16.3% and 17.2%, respectively. During hospitalization, there were 14 (0.9%) episodes of symptomatic VTE, 12 (86%) of which occurred in patients receiving prophylaxis. VTE rate was 1.3% among patients with VTE risk that received prophylaxis and 3.5% in patients that also had one risk factor that might contraindicate anticoagulant use.ConclusionsIn a setting characterized by high thromboprophylaxis compliance most of the episodes occurred in patients receiving pharmacological prophylaxis. Patients with combined VTE and bleeding risk factors showed the highest rate of both symptomatic VTE and prophylaxis failure.