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Aaron B Holley1, Lisa K Moores, Jeffrey L Jackson

  • 1Department of Medicine, Walter Reed Army Medical Center, Washington, DC 20015, USA. aholley@hotmail.com

Thrombosis Research
|May 19, 2005
PubMed
Summary

Internal medicine physicians often underestimate venous thromboembolic (VTE) disease risk in elderly patients, leading to inadequate prophylaxis. Enhanced education is crucial to improve prevention strategies for this vulnerable population.

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Area of Science:

  • Internal Medicine
  • Vascular Medicine
  • Patient Safety

Background:

  • Elderly patients on medicine wards have high risk for venous thromboembolic (VTE) disease due to multiple comorbidities.
  • Current risk assessment and prophylaxis guidelines are lacking for this specific patient group.

Purpose of the Study:

  • To evaluate how clinicians assess VTE risk in elderly patients.
  • To determine the prophylaxis recommendations made by clinicians for at-risk patients.

Main Methods:

  • Internal medicine physicians reviewed eight clinical vignettes representing varying VTE risk levels.
  • Participants identified risk factors, rated patient VTE risk, and recommended prophylaxis strategies.

Main Results:

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  • Physicians identified some VTE risk factors but generally underestimated overall patient risk compared to a gold standard.
  • Risk assessment influenced prophylaxis choice, with underestimation leading to less frequent heparin use in low-risk and potentially inadequate prophylaxis in high-risk cases.
  • Agreement among responders was good (k=0.62), but moderate when compared to the gold standard (k=0.42).

    • Conclusions:

    • Internal medicine physicians can identify some VTE risk factors but tend to underestimate overall risk.
    • Underestimation of VTE risk leads to less aggressive preventative measures, increasing the risk of inpatient complications.
    • Continuous medical education is vital to improve VTE prophylaxis and reduce preventable inpatient events.