Venous Thromboembolism Prophylaxis: Inadequate and Overprophylaxis When Comparing Perceived Versus Calculated Risk

Area of Science:

• Medical research
• Clinical practice guidelines
• Patient safety

Background:

• Venous thromboembolism (VTE) prophylaxis guidelines mandate risk stratification to guide treatment.
• Accurate risk assessment is crucial for appropriate VTE prophylaxis selection.
• Current practices may not align with established VTE risk prediction models.

Purpose of the Study:

• To evaluate adherence to VTE prophylaxis guidelines based on documented risk stratification.
• To compare documented VTE risk assessment with calculated risk using the Padua Prediction Score.
• To assess the appropriateness of chemical versus mechanical prophylaxis and associated costs.

Main Methods:

• Retrospective review of 437 adult patients on general medical wards.
• Analysis of VTE prophylaxis documentation and Padua Prediction Score calculations.
• Evaluation of risk stratification accuracy, prophylaxis type, and cost-benefit.

Main Results:

• Only 54.9% of patients had appropriate VTE risk stratification documented.
• A significant number of low-risk patients received unnecessary chemical prophylaxis (182/240).
• High-risk patients sometimes received inadequate prophylaxis (23/197), with no reported VTE events.

Conclusions:

• Clinical impression of VTE risk often mismatches calculated risk, leading to overtreatment.
• There is a clear tendency towards overtreatment with chemical VTE prophylaxis.
• Integrating VTE risk calculators into electronic health records is recommended to enhance guideline adherence.