Patients Admitted with Acute Abdominal Conditions Are At High Risk for Development of Symptomatic Venous Thromboembolism (Vte) But Often Fail to Receive Adequate Prophylaxis
Emily Pearsall*2, Ujash Sheth2, Darlene Fenech3,1, Marg Mckenzie2, J. Charles Victor4, Robin S. Mcleod1,2
1Surgery, University of Toronto, Toronto, ON, Canada; 2Surgery, Mount Sinai Hospital, Toronto, ON, Canada; 3Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; 4Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
Introduction:There is Level I evidence supporting the use of venous thromboembolism (VTE) prophylaxis in patients admitted with acute medical conditions. Best Practice in General Surgery was initiated to standardize care based on best evidence at seven adult teaching hospitals in Toronto. The aim of this study was to determine the frequency with which VTE prophylaxis was administered appropriately as well as the frequency of symptomatic VTE in patients admitted with acute abdominal conditions.Methods:Charts of 350 patients (50 from each of the seven adult teaching hospitals) admitted with acute abdominal conditions and who did not have surgery for at least 24 hours following admission were audited to identify whether they received VTE prophylaxis, timing, type and factors affecting prescription of VTE prophylaxis. As well, the rate of symptomatic VTE was recorded. Results:Of 350 patients (173 males, 177 females, mean age 64.7), 152 (43.4%) were admitted for bowel obstruction, 9 (2.6%) for acute diverticulitis, 67 (19.1%) for biliary conditions and 122 (34.9%) for other conditions. Eighty (22.9%) patients had cancer. Sixty-one (17.4%) had a history of cancer. Fourteen (4%) had a history for VTE. One hundred and forty-two (40.6%) patients had surgery (mean time 5.44 days) following admission. Two hundred and forty seven (70.6%) received prophylaxis (174 unfractionated heparin, 73 low molecular weight heparin) at time of admission (96.8%) or prior to surgery (2.8%). VTE prophylaxis prescription varied according to hospital (range 46-84%), disease (range 63-75%), and surgery/no surgery (78.2 vs 64.2%). Overall, 12 patients (3.4%) developed symptomatic VTE. Two (16.7%) had a prior history of VTE. Eleven (91.7%) received prophylaxis. Conclusions:Patients admitted with acute abdominal conditions are at high risk for the development of symptomatic VTE. There is variation in the rate of VTE but a gap in care exists. Knowledge transfer strategies are required to ensure all patients receive adequate prophylaxis.
Back to Program
