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Double Trouble for 2,609 Hospitalized Medical Patients Who Developed Deep Vein Thrombosis^*

Prophylaxis Omitted More Often and Pulmonary Embolism More Frequent

^* From the Cardiovascular Division (Dr. Piazza), Beth Israel Deaconess Medical Center, Boston, MA; and the Cardiovascular Division (Drs. Seddighzadeh and Goldhaber), Brigham and Women’s Hospital, Department of Medicine, Harvard Medical School, Boston, MA.

Correspondence to: Gregory Piazza, MD, Cardiovascular Division, Beth Israel Deaconess Medical Center, 1 Deaconess Rd, Baker 4, Boston, MA 02215; e-mail: gpiazza{at}bidmc.harvard.edu

Abstract

Background: Hospitalized patients with medical illness are especially susceptible to the development of venous thromboembolism (VTE).

Methods: To improve our understanding of the demographics, comorbidities, risk factors, clinical presentation, prophylaxis, and treatment of hospitalized medical patients with deep vein thrombosis (DVT), we evaluated hospitalized medical patients in a prospective registry of 5,451 consecutive ultrasound-confirmed DVT patients at 183 institutions in the United States.

Results: Of those patients who participated in the registry, 2,609 (48%) were hospitalized medical patients. Compared with 1,953 hospitalized nonmedical patients with DVT, medical patients with DVT experienced pulmonary embolism (PE) more often (22.2% vs 15.5%, respectively; p < 0.0001). However, medical patients in whom DVT developed had received VTE prophylaxis far less frequently than nonmedical patients (25.4% vs 53.8%, respectively; p < 0.0001). The underutilization of VTE prophylaxis among hospitalized medical patients extended to both pharmacologic and mechanical modalities. In a multivariable logistic regression analysis of all hospitalized VTE patients, status as a medical patient was negatively associated with receiving prophylaxis (adjusted odds ratio, 0.47; 95% confidence interval, 0.28 to 0.78).

Conclusions: Hospitalized medical patients face "double trouble." First, during hospitalization for a reason other than VTE, VTE prophylaxis is omitted in medical patients more often than in nonmedical patients. Second, when VTE develops as a complication of hospitalization, hospitalized medical patients experience PE more often. Further studies should focus on understanding why prophylaxis is often omitted in hospitalized medical patients and on improving its implementation in this vulnerable population.

Key Words: deep vein thrombosis • medical patients • prevention • prophylaxis • pulmonary embolism • risk factors • treatment • venous thromboembolism