Prevention of Venous Thromboembolism: Practice Patterns in 17 Geographically Diverse Long Term Care Facilities in the United States: Part 1 of 2 (an AMDA Foundation Project)

Thiruvinvamalai S. Dharmarajan, Aman Nanda, Bikash Agarwal, Parag Agnihotri, G. L. Doxsie, Murthy Gokula, Ashkan Javaheri, Madhusudhana R. Kanagala, Anna Skokowska-Lebelt, Prasuna Madireddy, Sourya Mahapatra, P. Murakonda, Ram Rao S Muthavarapu, Mennakshi Patel, Christopher Patterson, Kathleen Soch, Anna Troncales, Kamal Yaokim, Robin Kroft, Edward P. Norkus

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Introduction: Current guidelines recommend antithrombotic prophylaxis for venous thromboembolism (VTE) using risk assessment, factoring contraindications. This report represents a summary of current practice patterns to prevent VTE in long term care as Phase 1 of a 3-phase educational intervention study. Phase 1 Participants: Participants were 376 new admissions/readmissions (77 ± 12 [SD] years; 67% female) from 17 geographically diverse long term care facilities (3260 total beds). Measurements: The process describes current VTE prophylaxis (VTE-P) practices; a companion article describes the educational intervention (Phase 2) and outcome (Phase 3). Phase 1 data were collected on use of nonpharmacological measures and antithrombotic drugs for VTE-P between July and September 2009. Results: Indications for VTE-P were evident in 85% of new admissions, of which two-thirds received VTE-P. Contraindications for anticoagulation were observed in 54.8% of admissions, including quality of life or patient/caregiver wishes. Logistic regression analysis predicted no relationship between any indication for or any contraindication to VTE-P and use of VTE-P, suggesting an inadequate understanding of current clinical practice guidelines. Conclusions: Residents of long term care have significant comorbidity that poses risk for VTE; although many received VTE-P, contraindications were common, warranting individualized considerations. The likelihood of VTE-P was greatest following orthopedic surgery, severe trauma, and medical illness.

Original languageEnglish (US)
Pages (from-to)298-302
Number of pages5
JournalJournal of the American Medical Directors Association
Volume13
Issue number3
DOIs
StatePublished - Mar 2012

Fingerprint

Venous Thromboembolism
Long-Term Care
Practice Guidelines
Caregivers
Orthopedics
Comorbidity
Logistic Models
Regression Analysis
Quality of Life
Guidelines

Keywords

  • DVT
  • Mechanical measures to prevent VTE
  • Pulmonary embolism
  • Venous thromboembolism
  • Venous thromboembolism prophylaxis in LTC
  • VTE prophylaxis

ASJC Scopus subject areas

  • Medicine(all)
  • Nursing(all)
  • Health Policy

Cite this

Prevention of Venous Thromboembolism : Practice Patterns in 17 Geographically Diverse Long Term Care Facilities in the United States: Part 1 of 2 (an AMDA Foundation Project). / Dharmarajan, Thiruvinvamalai S.; Nanda, Aman; Agarwal, Bikash; Agnihotri, Parag; Doxsie, G. L.; Gokula, Murthy; Javaheri, Ashkan; Kanagala, Madhusudhana R.; Skokowska-Lebelt, Anna; Madireddy, Prasuna; Mahapatra, Sourya; Murakonda, P.; Muthavarapu, Ram Rao S; Patel, Mennakshi; Patterson, Christopher; Soch, Kathleen; Troncales, Anna; Yaokim, Kamal; Kroft, Robin; Norkus, Edward P.

In: Journal of the American Medical Directors Association, Vol. 13, No. 3, 03.2012, p. 298-302.

Research output: Contribution to journalArticle

Dharmarajan, TS, Nanda, A, Agarwal, B, Agnihotri, P, Doxsie, GL, Gokula, M, Javaheri, A, Kanagala, MR, Skokowska-Lebelt, A, Madireddy, P, Mahapatra, S, Murakonda, P, Muthavarapu, RRS, Patel, M, Patterson, C, Soch, K, Troncales, A, Yaokim, K, Kroft, R & Norkus, EP 2012, 'Prevention of Venous Thromboembolism: Practice Patterns in 17 Geographically Diverse Long Term Care Facilities in the United States: Part 1 of 2 (an AMDA Foundation Project)', Journal of the American Medical Directors Association, vol. 13, no. 3, pp. 298-302. https://doi.org/10.1016/j.jamda.2011.04.016
Dharmarajan, Thiruvinvamalai S. ; Nanda, Aman ; Agarwal, Bikash ; Agnihotri, Parag ; Doxsie, G. L. ; Gokula, Murthy ; Javaheri, Ashkan ; Kanagala, Madhusudhana R. ; Skokowska-Lebelt, Anna ; Madireddy, Prasuna ; Mahapatra, Sourya ; Murakonda, P. ; Muthavarapu, Ram Rao S ; Patel, Mennakshi ; Patterson, Christopher ; Soch, Kathleen ; Troncales, Anna ; Yaokim, Kamal ; Kroft, Robin ; Norkus, Edward P. / Prevention of Venous Thromboembolism : Practice Patterns in 17 Geographically Diverse Long Term Care Facilities in the United States: Part 1 of 2 (an AMDA Foundation Project). In: Journal of the American Medical Directors Association. 2012 ; Vol. 13, No. 3. pp. 298-302.
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abstract = "Introduction: Current guidelines recommend antithrombotic prophylaxis for venous thromboembolism (VTE) using risk assessment, factoring contraindications. This report represents a summary of current practice patterns to prevent VTE in long term care as Phase 1 of a 3-phase educational intervention study. Phase 1 Participants: Participants were 376 new admissions/readmissions (77 ± 12 [SD] years; 67{\%} female) from 17 geographically diverse long term care facilities (3260 total beds). Measurements: The process describes current VTE prophylaxis (VTE-P) practices; a companion article describes the educational intervention (Phase 2) and outcome (Phase 3). Phase 1 data were collected on use of nonpharmacological measures and antithrombotic drugs for VTE-P between July and September 2009. Results: Indications for VTE-P were evident in 85{\%} of new admissions, of which two-thirds received VTE-P. Contraindications for anticoagulation were observed in 54.8{\%} of admissions, including quality of life or patient/caregiver wishes. Logistic regression analysis predicted no relationship between any indication for or any contraindication to VTE-P and use of VTE-P, suggesting an inadequate understanding of current clinical practice guidelines. Conclusions: Residents of long term care have significant comorbidity that poses risk for VTE; although many received VTE-P, contraindications were common, warranting individualized considerations. The likelihood of VTE-P was greatest following orthopedic surgery, severe trauma, and medical illness.",
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AU - Nanda, Aman

AU - Agarwal, Bikash

AU - Agnihotri, Parag

AU - Doxsie, G. L.

AU - Gokula, Murthy

AU - Javaheri, Ashkan

AU - Kanagala, Madhusudhana R.

AU - Skokowska-Lebelt, Anna

AU - Madireddy, Prasuna

AU - Mahapatra, Sourya

AU - Murakonda, P.

AU - Muthavarapu, Ram Rao S

AU - Patel, Mennakshi

AU - Patterson, Christopher

AU - Soch, Kathleen

AU - Troncales, Anna

AU - Yaokim, Kamal

AU - Kroft, Robin

AU - Norkus, Edward P.

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N2 - Introduction: Current guidelines recommend antithrombotic prophylaxis for venous thromboembolism (VTE) using risk assessment, factoring contraindications. This report represents a summary of current practice patterns to prevent VTE in long term care as Phase 1 of a 3-phase educational intervention study. Phase 1 Participants: Participants were 376 new admissions/readmissions (77 ± 12 [SD] years; 67% female) from 17 geographically diverse long term care facilities (3260 total beds). Measurements: The process describes current VTE prophylaxis (VTE-P) practices; a companion article describes the educational intervention (Phase 2) and outcome (Phase 3). Phase 1 data were collected on use of nonpharmacological measures and antithrombotic drugs for VTE-P between July and September 2009. Results: Indications for VTE-P were evident in 85% of new admissions, of which two-thirds received VTE-P. Contraindications for anticoagulation were observed in 54.8% of admissions, including quality of life or patient/caregiver wishes. Logistic regression analysis predicted no relationship between any indication for or any contraindication to VTE-P and use of VTE-P, suggesting an inadequate understanding of current clinical practice guidelines. Conclusions: Residents of long term care have significant comorbidity that poses risk for VTE; although many received VTE-P, contraindications were common, warranting individualized considerations. The likelihood of VTE-P was greatest following orthopedic surgery, severe trauma, and medical illness.

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