Regular ArticleVenous thromboembolism prophylaxis in medical inpatients: a retrospective chart review
Section snippets
Background
Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is a major cause of mortality and morbidity in hospitalized patients. In the absence of prophylaxis, the risk of venographic VTE in medical patients is, on average, 16%. This is comparable to the risk in moderate risk surgical patients [1]. Autopsy studies carried out in hospitalized patients have revealed that PE contributed to death in 15.6% of cases. Of the PE deaths, 18% occurred in surgical
Patients
The study population consisted of consecutive inpatients admitted to the medical wards of one of two McMaster University affiliated teaching hospitals (McMaster University Medical Centre (MUMC) and the Henderson Hospital) between October 10, 2001 and December 11, 2001. Each hospital has 50 inpatient medical beds, and most of the patients are admitted to the wards via the Emergency Department. MUMC has a clinical teaching unit (attending physicians and housestaff) whereas the Henderson does not.
Study design
Study population
For the period from October 10, 2001 to December 11, 2001, the charts of 756 patients were reviewed (299 from MUMC and 457 from Henderson Hospital). Three hundred ten (41%) patients were excluded (see Table 1). Thus, the study population consisted of 446 (59%) patients: 208 were from MUMC and 238 were from Henderson Hospital.
Demographic data
The mean average age of the included patients was 67 years (range 16–98 years). The mean average expected length of stay at MUMC was 4.5 days. Charts of patients admitted
Interpretation
Our study of admitted medical patients at two McMaster University affiliated teaching hospitals revealed that VTE prophylaxis is given to only about one third of patients. Even in subgroups of patients with two or more risk factors for VTE, prophylaxis was given in less than 50%. Consensus conferences universally recommend (Grade A evidence) the use of heparin for VTE prophylaxis in moderate to high risk medical patients. Each of the two McMaster University affiliated hospitals has a formal
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