Thromboprophylaxis in Patients at Risk for Venous Thromboembolism
Thromboprophylaxis in Patients at Risk for Venous Thromboembolism
Purpose: According to guidelines from the American College of Chest Physicians, low-molecular-weight heparin (LMWH) and unfractionated heparin (UFH) should be prescribed to medical (nonsurgical) patients at high risk of venous thromboembolism. Thromboprophylaxis and mortality rates were determined in medical inpatients with indications for thromboprophylaxis. Cost differences between patient groups were investigated and are discussed.
Summary: Using Solucient's ACTracker Inpatient Database, medical discharges between January 2001 and December 2004 were extracted and patients who had indications for thromboprophylaxis (acute myocardial infarction, ischemic stroke, cancer, heart failure, or severe lung disease) were identified. Patients < 40 years or with deep-vein thrombosis or pulmonary embolism, active peptic ulcer, malignant hypertension, blood disease, HIV infection, or intubation of gastrointestinal or respiratory tract were excluded. Rates of thromboprophylaxis and mortality were compared between groups. Mean total drug costs and hospital costs per patient discharge were compared between patient groups.
Of 12,887,080 medical discharges extracted from 330 hospitals, there were 2,367,362 patients with indications for thromboprophylaxis. Patients were subdivided on the basis of whether they received thromboprophylaxis (n = 717,850) or not (n = 1,649,512). The thromboprophylaxis rate was low, despite increasing from 26% to 33% over the study period. Patients receiving thromboprophylaxis had significantly lower risk-adjusted mortality rates than those who did not (p < 0.001), except those with ischemic stroke. The mean total drug cost per patient receiving LMWH and UFH ($791 and $569, respectively) was higher than for patients not receiving thromboprophylaxis ($372) (p < 0.001). The mean total hospital cost per patient receiving UFH ($7615) was higher than for LMWH ($6866, p < 0.001).
Conclusion: The thromboprophylaxis rate among medical patients was low, with no significant improvement between 2001 and 2004. Thromboprophylaxis can impact patient mortality rates. Economic evaluation revealed that the use of LMWH for thromboprophylaxis in at-risk medical patients was associated with higher total drug costs but lower total hospital costs than UFH. Efforts should be made to increase clinicians' awareness of clinical guidelines.
Low-molecular-weight heparin (LMWH) and unfractionated heparin (UFH) have been proven to be safe and effective in surgical patients and are widely used for the prevention of venous thromboembolism (VTE) in these patients. According to the American College of Chest Physicians (ACCP) guidelines, anticoagulants should also be prescribed as thromboprophylaxis to medical (nonsurgical) inpatients who are at high risk of VTE (deep-vein thrombosis [DVT] and pulmonary embolism [PE]). Evidence of the effectiveness of anticoagulants for the prevention of DVT in the medical population is accumulating. Comparisons of the clinical benefits and relative costs of LMWH and UFH are of increasing importance, because of rising health care costs.
Recent registry and single-center studies investigating thromboprophylaxis in medical patients at risk of VTE have found low rates of prophylaxis in these patients despite the presence of guideline recommendations.
In the present study, the thromboprophylaxis rates for at-risk medical patients were determined from a large inpatient database encompassing over 500 hospitals across the U.S. This large sample size allows for the reporting of the real-world prophylaxis rates across the U.S., as well as reporting temporal trends between 2001 and 2004. Furthermore, it was determined whether mortality rates were lower for patients who received thromboprophylaxis compared with those who did not. Both total drug and total hospital costs were compared among patient groups with adjustment for potential confounding factors.
Abstract and Introduction
Abstract
Purpose: According to guidelines from the American College of Chest Physicians, low-molecular-weight heparin (LMWH) and unfractionated heparin (UFH) should be prescribed to medical (nonsurgical) patients at high risk of venous thromboembolism. Thromboprophylaxis and mortality rates were determined in medical inpatients with indications for thromboprophylaxis. Cost differences between patient groups were investigated and are discussed.
Summary: Using Solucient's ACTracker Inpatient Database, medical discharges between January 2001 and December 2004 were extracted and patients who had indications for thromboprophylaxis (acute myocardial infarction, ischemic stroke, cancer, heart failure, or severe lung disease) were identified. Patients < 40 years or with deep-vein thrombosis or pulmonary embolism, active peptic ulcer, malignant hypertension, blood disease, HIV infection, or intubation of gastrointestinal or respiratory tract were excluded. Rates of thromboprophylaxis and mortality were compared between groups. Mean total drug costs and hospital costs per patient discharge were compared between patient groups.
Of 12,887,080 medical discharges extracted from 330 hospitals, there were 2,367,362 patients with indications for thromboprophylaxis. Patients were subdivided on the basis of whether they received thromboprophylaxis (n = 717,850) or not (n = 1,649,512). The thromboprophylaxis rate was low, despite increasing from 26% to 33% over the study period. Patients receiving thromboprophylaxis had significantly lower risk-adjusted mortality rates than those who did not (p < 0.001), except those with ischemic stroke. The mean total drug cost per patient receiving LMWH and UFH ($791 and $569, respectively) was higher than for patients not receiving thromboprophylaxis ($372) (p < 0.001). The mean total hospital cost per patient receiving UFH ($7615) was higher than for LMWH ($6866, p < 0.001).
Conclusion: The thromboprophylaxis rate among medical patients was low, with no significant improvement between 2001 and 2004. Thromboprophylaxis can impact patient mortality rates. Economic evaluation revealed that the use of LMWH for thromboprophylaxis in at-risk medical patients was associated with higher total drug costs but lower total hospital costs than UFH. Efforts should be made to increase clinicians' awareness of clinical guidelines.
Introduction
Low-molecular-weight heparin (LMWH) and unfractionated heparin (UFH) have been proven to be safe and effective in surgical patients and are widely used for the prevention of venous thromboembolism (VTE) in these patients. According to the American College of Chest Physicians (ACCP) guidelines, anticoagulants should also be prescribed as thromboprophylaxis to medical (nonsurgical) inpatients who are at high risk of VTE (deep-vein thrombosis [DVT] and pulmonary embolism [PE]). Evidence of the effectiveness of anticoagulants for the prevention of DVT in the medical population is accumulating. Comparisons of the clinical benefits and relative costs of LMWH and UFH are of increasing importance, because of rising health care costs.
Recent registry and single-center studies investigating thromboprophylaxis in medical patients at risk of VTE have found low rates of prophylaxis in these patients despite the presence of guideline recommendations.
In the present study, the thromboprophylaxis rates for at-risk medical patients were determined from a large inpatient database encompassing over 500 hospitals across the U.S. This large sample size allows for the reporting of the real-world prophylaxis rates across the U.S., as well as reporting temporal trends between 2001 and 2004. Furthermore, it was determined whether mortality rates were lower for patients who received thromboprophylaxis compared with those who did not. Both total drug and total hospital costs were compared among patient groups with adjustment for potential confounding factors.
