An evaluation of thromboembolism prophylaxis in acutely ill medical patients

To examine the frequency and adequacy of thromboprophylaxis in acutely ill medical patients hospitalised in a primary-tertiary care hospital.

We carried out a cross-sectional study of 266 patients hospitalised in the three medical services of the University Hospital of Geneva. After exclusion of patients (64) treated by therapeutic anticoagulation, 202 patients were included. The appropriateness of thromboprophylaxis was assessed by means of explicit criteria developed by the Hôpital Lariboisière, Paris, France.

Overall, 87 patients (43.1%) received thromboprophylaxis. With explicit criteria, this percentage decreased to 37.6% (p = 0.25). According to the explicit criteria used, about half of the patients were unnecessarily treated, whereas 42% of the patients who should have been treated were not. Agreement between implicit criteria (or observed treatment rate) and explicit criteria assessed by kappa coefficient is 0.2. Two services (A, B) had an overuse of thromboprophylaxis (p = 0.002) and service C tended to under-use thromboprophylaxis (p = 0.45).

Even though the appropriateness of the applied explicit criteria has not been thoroughly validated, these results suggest that implicit criteria are associated with considerable uncertainty leading to both over or under-use of thromboprophylaxis. Further research is needed to better understand thromboembolic risk factors in acutely ill medical patients and to elaborate explicit evidence-based criteria for thromboprophylaxis in this setting.