Use of deep venous thrombosis prophylaxis by family physicians

Accumulated data indicate that the administration of low-dose subcutaneous heparin reduces the incidence of deep venous thrombosis in high-risk surgical and medical patients. Because deep venous thrombosis predisposes to pulmonary embolism, it is generally accepted that reducing deep venous thrombosis will reduce pulmonary embolism, the most common preventable cause of death in hospitalized patients. There are few data, however, regarding physicians' use of heparin for deep venous thrombosis prophylaxis in medical patients.

We reviewed charts of medical patients aged 50 years and older who were admitted to family practice services in a community teaching hospital and excluded patients who were not candidates for heparin prophylaxis.

Eighty (65 percent) of 123 patients received heparin for deep venous thrombosis prophylaxis. Patients admitted to a residency teaching service were more likely to receive heparin for deep venous thrombosis prophylaxis than were patients admitted to nonteaching services (odds ratio 3.37, 95 percent confidence interval 1.26-9.21, P = 0.012). An association between the patient's number of risk factors for deep venous thrombosis and likelihood of receiving deep venous thrombosis prophylaxis approached statistical significance (P = 0.078).

In our institution, heparin for deep venous thrombosis prophylaxis is frequently but not uniformly prescribed for appropriately selected family practice inpatients. No similar data for nonsurgical patients were found for comparison.