Differences in venous thromboembolism prophylaxis between gastroenterology and cardiology inpatients.

Objective The multinational cross-sectional study ENDORSE showed in 2008, that most inpatients in Germany treated on internal medicine wards with increased risk of venous thromboembolism (VTE) receive drug-based prophylaxis. The study did not discriminate between different subspecialties. While cardiologists usually treat patients with thrombotic or thromboembolic diseases, their gastroenterology colleagues see more patients with gastrointestinal bleeding complications. Thus, we hypothesized that the prescription of VTE-prophylaxis will be influenced by the field of specialization of treating physicians.

Material and Methods We performed a retrospective chart review of patients on the cardiology and gastroenterology internal medicine wards of our university hospital. A total of 1917 consecutive patients on the cardiology and gastroenterology wards were screened. Patients with clear indication for anticoagulation and contraindication against antithrombotic treatment were excluded. To determine the risk of a VTE and bleeding, quantitative risk assessment models (Padua Score, IMPROVE Score, IMPROVE-Bleeding Score and Has Bled Score) were used. We correlated the risk of VTE and bleeding with the likelihood of receiving VTE-prophylaxis.

Results A total of 450 patients per specialty were included in this study. In the group of low-risk patients for VTE based on Padua Score 55.19 % patients treated on gastroenterology and 82.13 % patients treated on cardiology wards received drug-based thrombosis prophylaxis (OR = 3.73, 95 % CI 2.43-5.73). Stratified by IMPROVE Score 64.18 % patients treated on gastroenterology and 84.52 % treated on cardiology wards received prophylaxis, respectively (OR = 3.05, 95 % CI 2.11-4.39). In the group of high-risk patients, stratified by Padua Score, 85.45 % gastroenterology and 93.26 % cardiology patients for VTE (OR = 2.35, 95 % CI 0.92-6) received thrombosis prophylaxis. Stratified by IMPROVE Score the percentages were 85.45 for gastroenterology and 93.10 for cardiology wards (OR = 2.30, 95 % CI 0.45-11.61). Bleeding risk as calculated by IMPROVE-Bleeding and Has Bled Score did not influence treatment decision.

Conclusion We found that significant more cardiology low-risk patients received drug-based thrombosis prophylaxis compared to gastroenterology patients. No significant difference in thrombosis prophylaxis use between the two specialties was found in high-risk patients for VTE.

Publication History

Article published online:
18 June 2021