TY - JOUR
T1 - Prevention of Venous Thromboembolism
T2 - Practice Patterns in 17 Geographically Diverse Long Term Care Facilities in the United States: Part 1 of 2 (an AMDA Foundation Project)
AU - Dharmarajan, T. S.
AU - Nanda, Aman
AU - Agarwal, Bikash
AU - Agnihotri, Parag
AU - Doxsie, G. L.
AU - Gokula, Murthy
AU - Javaheri, Ashkan
AU - Kanagala, M.
AU - Lebelt, Anna S.
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.
N1 - Funding Information:
This study was sponsored by the AMDA Foundation and supported by a grant from Sanofi-Aventis .
PY - 2012/3
Y1 - 2012/3
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.
AB - 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.
KW - DVT
KW - Mechanical measures to prevent VTE
KW - Pulmonary embolism
KW - VTE prophylaxis
KW - Venous thromboembolism
KW - Venous thromboembolism prophylaxis in LTC
UR - http://www.scopus.com/inward/record.url?scp=84857191383&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84857191383&partnerID=8YFLogxK
U2 - 10.1016/j.jamda.2011.04.016
DO - 10.1016/j.jamda.2011.04.016
M3 - Article
C2 - 21621480
AN - SCOPUS:84857191383
SN - 1525-8610
VL - 13
SP - 298
EP - 302
JO - Journal of the American Medical Directors Association
JF - Journal of the American Medical Directors Association
IS - 3
ER -