Abstract

Introduction Estimates for patients at risk of venous thromboembolism (VTE) in US acute care hospitals total approximately 4 million surgical and 8 million medical patients annually. However, limited data are available regarding practices in VTE prevention in the acute care setting. The ENDORSE (Epidemiologic International Day for the Evaluation of Patients at Risk of Venous Thrombosis in the Acute Hospital Care Setting) study is a worldwide survey of inpatients in acute hospital care. We assessed data from US acute care hospitals to determine the prevalence of VTE risk and proportion of at-risk patients receiving prophylaxis in accordance with current ACCP guidelines.

Methods During the period August 2006 to January 2007, 9257 patients were enrolled from 81 randomly-selected US acute care hospitals. All medical patients ≥40 years, surgical patients ≥18 years, or patients ≥18 years admitted for non-surgical trauma were eligible for the study. Patients admitted to an ineligible ward, with missing data, or admitted solely for the treatment of VTE were excluded from the analysis. Patient charts were reviewed during a single day, pre-defined visit, with the evaluation criteria including medical history, admission and post-admission diagnoses, type of surgery, bleeding risks, and initiation and type of prophylaxis. The ACCP consensus guidelines were used to evaluate VTE risk and prophylaxis use in enrolled patients.

Results Of the 9257 study patients, 44% and 56% were surgical and medical, respectively. 78% and 52% of surgical and medical patients were judged at risk for VTE, respectively. Of these, 29% of surgical patients and 52% of medical patients failed to receive recommended types of prophylaxis (Table). Among at-risk patients who received recommended types of VTE prophylaxis, a majority received anticoagulants (90% surgical, 97% medical).

Table:

VTE risk and prescription of recommended types of prophylaxis in US acute care hospitals

US patients [X, range*]At-risk for VTE [X, range*]At-risk patients who received ACCP-recommended prophylaxis [X, range*]
*Mean and range across all 81 US hospitals 
All (N=9257) 5885 [64%] 3536 [60%] 
Surgical (N=4061) [44%,13–94] 3165 [78%, 21–100] 2244 [71%, 0–100] 
Medical (N=5196) [56%, 6–87] 2720 [52%, 19–100] 1292 [48%, 0–100] 
US patients [X, range*]At-risk for VTE [X, range*]At-risk patients who received ACCP-recommended prophylaxis [X, range*]
*Mean and range across all 81 US hospitals 
All (N=9257) 5885 [64%] 3536 [60%] 
Surgical (N=4061) [44%,13–94] 3165 [78%, 21–100] 2244 [71%, 0–100] 
Medical (N=5196) [56%, 6–87] 2720 [52%, 19–100] 1292 [48%, 0–100] 

Conclusions These data from US acute care hospitals parallel the global ENDORSE study findings of the high prevalence of VTE risk and suboptimal provision of ACCP-recommended prophylaxis. Although a higher proportion of surgical patients were judged to be at risk of VTE, the absolute number of hospitalized medical patients was higher and half of these did not receive adequate VTE prophylaxis. Our data highlight the continued need for strategies to ensure that hospital patients at risk of VTE are identified and provided with adequate VTE prophylaxis.

Author notes

Disclosure:Consultancy: All authors were members of the ENDORSE Steering Committee. V.F.T. consultancy for sanofi-aventis, Bayer. J.F.B. consultancy for AstraZeneca and GSK. A.T.C. consultancy for many pharmaceutical companies, including AstraZeneca, Bayer, Boheringer-Ingelheim, BMS, Daiichi, GSK, Johnson & Johnson, Mitsubishi Pharma, Organon, Pfizer, sanofi-aventis, Schering-Plough, and Takeda. S.G. consultancy for Bayer, Emisphere, sanofi-aventis, Boehringer-Ingelheim, BMS. A.K.K. consultancy for sanofi-aventis. F.A.A. consultancy for sanofi-aventis. Research Funding: ENDORSE was sponsored by sanofi-aventis. A.T.C. clinical trial funding from pharmaceutical companies, including AstraZeneca, Bayer, Boheringer-Ingelheim, BMS, Daiichi, GSK, Johnson & Johnson, Mitsubishi Pharma, Organon, Pfizer, sanofi-aventis, Schering-Plough, and Takeda. V.F.T. grant/research support from sanofi-aventis. S.G. grant/research support from sanofi-aventis, GSK, BMS, Boehringer-Ingelheim, Eisai. F.A.A. grant/research support from sanofi-aventis. Honoraria Information: A.K.K. honoraria from sanofi-aventis for participation in ENDORSE.