Download PDF
CC BY 4.0 · TH Open 2020; 04(03): e218-e219
DOI: 10.1055/s-0040-1716720
Original Article

Factors Influencing Prescribers' Decision for Extending Venous Thromboembolism Prophylaxis in the Medical Patient Population following Hospitalization

Alex M. Ebied
1   Department of Clinical Sciences, High Point University Fred Wilson School of Pharmacy, High Point, North Carolina, United States
,
Jeremiah Jessee
2   Department of Pharmacy, Novant Health Forsyth Medical Center, Winston-Salem, North Carolina, United States
,
Yiqing Chen
3   Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, Florida, United States
,
Jason Konopack
4   Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville, Florida, United States
,
Nila Radhakrishnan
5   Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, United States
,
Christina E. DeRemer
3   Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, Florida, United States
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Introduction Venous thromboembolism (VTE) prophylaxis during hospitalization has clearly defined metrics for risk stratification and practice policy employed to ensure processes of adherence. However, acceptance for practice or even the level and timeline of risk is less clear during the immediate time after hospitalization. With emerging new oral anticoagulant agents, data are available that may influence prescribing in the outpatient setting following hospitalization. A survey was created to determine the level of acceptance or influences for practice surrounding continuation of anticoagulation following hospitalization.

Methods This study was designed as a single-center survey of hospitalist and family medicine physician to assess influences to the physician's impression for risk of VTE prophylaxis and knowledge of therapy options.

Results Physicians reported depending heavily on medical center protocols for determining anticoagulation at hospital discharge. Prescribing postdischarge anticoagulation was reported to be affected by lack of comfort with prescribing oral medications and concerns with risk of bleeding for all types of anticoagulation outweighing the perceived benefit. Additionally, the decision whether to prescribe these medications at discharge was reported to be related to perceived cost and other patient barriers such as concerns over route of administration.

Conclusion Concerns for bleeding were an influence and likely resulted in shorter duration for VTE prophylaxis being prescribed posthospitalization.

Keywords

VTE prophylaxis - venous thromboembolism prophylaxis - physician influences


Publication History

Received: 20 March 2020

Accepted: 11 August 2020

Article published online:
11 September 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Stuttgart · New York

 

  • References

  • 1 Spyropoulos AC, Raskob GE. New paradigms in venous thromboprophylaxis of medically ill patients. Thromb Haemost 2017; 117 (09) 1662-1670
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 Rosenberg D, Eichorn A, Alarcon M, McCullagh L, McGinn T, Spyropoulos AC. External validation of the risk assessment model of the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) for medical patients in a tertiary health system. J Am Heart Assoc 2014; 3 (06) e001152
    CrossrefPubMedGoogle Scholar
  • 3 Germini F, Agnelli G, Fedele M. , et al. Padua prediction score or clinical judgment for decision making on antithrombotic prophylaxis: a quasi-randomized controlled trial. J Thromb Thrombolysis 2016; 42 (03) 336-339
    CrossrefPubMedGoogle Scholar
  • 4 Cohen AT, Spiro TE, Büller HR. , et al; MAGELLAN Investigators. Rivaroxaban for thromboprophylaxis in acutely ill medical patients. N Engl J Med 2013; 368 (06) 513-523
    CrossrefPubMedGoogle Scholar
  • 5 Spyropoulos AC, Ageno W, Albers GW. , et al; MARINER Investigators. Rivaroxaban for thromboprophylaxis after hospitalization for medical illness. N Engl J Med 2018; 379 (12) 1118-1127
    CrossrefPubMedGoogle Scholar
  • 6 Goldhaber SZ, Leizorovicz A, Kakkar AK. , et al; ADOPT Trial Investigators. Apixaban versus enoxaparin for thromboprophylaxis in medically ill patients. N Engl J Med 2011; 365 (23) 2167-2177
    CrossrefPubMedGoogle Scholar
  • 7 Miao B, Chalupadi B, Clark B. , et al. Proportion of US hospitalized medically ill patients who may qualify for extended thromboprophylaxis. Clin Appl Thromb Hemost 2019; 25: 1076029619850897
    CrossrefPubMedGoogle Scholar
  • 8 Office of the Surgeon General, National Heart, Lung, and Blood Institute. The Surgeon General's Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism. Rockville, MD: Office of the Surgeon General (US); 2008
    Google Scholar
  • 9 Cohen AT, Tapson VF, Bergmann JF. , et al; ENDORSE Investigators. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet 2008; 371 (9610): 387-394
    CrossrefPubMedGoogle Scholar
  • 10 Cohen AT, Huang W, Harrington RA. , et al. Prevalence of major medical illnesses associated with venous thromboembolism risk in US hospitals. Poster presented at International Society on Thrombosis and Haemostasis 2017 Congress; July 8–13, 2017; Berlin, Germany:
    PubMedGoogle Scholar
  • 11 Dentali F, Douketis JD, Gianni M, Lim W, Crowther MA. Meta-analysis: anticoagulant prophylaxis to prevent symptomatic venous thromboembolism in hospitalized medical patients. Ann Intern Med 2007; 146 (04) 278-288
    CrossrefPubMedGoogle Scholar
  • 12 Cave B, Hough A, Dobesh PP. Extended venous thromboembolism prophylaxis in medically ill patients. Pharmacotherapy 2018; 38 (06) 597-609
    CrossrefPubMedGoogle Scholar
  • 13 Amin AN, Varker H, Princic N, Lin J, Thompson S, Johnston S. Duration of venous thromboembolism risk across a continuum in medically ill hospitalized patients. J Hosp Med 2012; 7 (03) 231-238
    CrossrefPubMedGoogle Scholar
  • 14 Kahn SR, Lim W, Dunn AS. , et al. Prevention of VTE in nonsurgical patients: antithrombotic therapy and prevention of thrombosis, American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141 (2, suppl) e195S-e226S
    CrossrefPubMedGoogle Scholar
  • 15 Cohen AT, Harrington RA, Goldhaber SZ. , et al; APEX Investigators. Extended Thromboprophylaxis with betrixaban in acutely ill medical patients. N Engl J Med 2016; 375 (06) 534-544
    CrossrefPubMedGoogle Scholar
  • 16 Gibson CM, Korjian S, Chi G. , et al; APEX Investigators. Comparison of fatal or irreversible events with extended-duration betrixaban versus standard dose enoxaparin in acutely ill medical patients: an APEX trial substudy. J Am Heart Assoc 2017; 6 (07) e006015
    CrossrefPubMedGoogle Scholar
  • 17 Gibson CM, Nafee T, Yee MK. , et al. Symptomatic event reduction with extended-duration betrixaban in acute medically ill hospitalized patients. Am Heart J 2018; 198: 84-90
    CrossrefPubMedGoogle Scholar
  • 18 Barbar S, Noventa F, Rossetto V. , et al. A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: the Padua Prediction Score. J Thromb Haemost 2010; 8 (11) 2450-2457
    CrossrefPubMedGoogle Scholar
  • 19 Woller SC, Stevens SM, Jones JP. , et al. Derivation and validation of a simple model to identify venous thromboembolism risk in medical patients. Am J Med 2011; 124 (10) 947-954.e2
    CrossrefPubMedGoogle Scholar
  • 20 Gibson CM, Spyropoulos AC, Cohen AT. , et al. The IMPROVEDD VTE Risk Score: Incorporation of D-Dimer into the IMPROVE Score to Improve Venous Thromboembolism Risk Stratification. TH Open 2017; 1 (01) e56-e65
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Doyle E. Extended VTE prophylaxis: reducing risk in post-discharge patients. Today's Hospitalist. 2019 . Available at: https://www.todayshospitalist.com/vte-risk-factors-post-discharge/ . Accessed May 26, 2020
    PubMedGoogle Scholar
  • 22 Schellong SM, Kaiser J, Bramlage P. Continuation of venous thromboembolism prophylaxis after hospital discharge into the outpatient setting: the ACCEPT study. J Thromb Thrombolysis 2015; 39 (02) 173-178
    CrossrefPubMedGoogle Scholar
  • 23 Nadarajan K, Balakrishnan T, Ling Yee M. , et al. The attitudes and beliefs of doctors towards deprescribing medications. Proceedings of Singapore Healthcare 2018; 27 (01) 41-48
    CrossrefPubMedGoogle Scholar