Prophylaxis of Venous Thromboembolism after Hospital Discharge in Internal Medicine: Findings from the Observational FADOI-NoTEVole Study

Abstract

Background and Aim Post-discharge prophylaxis for venous thromboembolism (VTE) is a challenging issue in patients hospitalised in Internal Medicine Units (IMUs). The aim of this study was to evaluate the frequency and the factors associated with post-discharge prophylaxis for VTE in IMUs.

Methods Multi-centre, retrospective study including consecutive patients who were admitted for any cause and discharged from an IMU.

Results Overall, 3,740 patients (mean age 74.1 ± 15.7 years) were included in the study at 38 IMUs in Italy. At discharge, the percentage of patients receiving pharmacological thromboprophylaxis was 16.0% (20.1% after excluding patients treated with anticoagulants for indications other than VTE prophylaxis). At multivariable analysis, history of ischaemic stroke, hypomobility ≥ 7 days, central venous catheter, ≥ 10 versus ≤ 5 days of hospital stay, use of corticosteroids, cancer, history of falls, availability of a caregiver, infections and age were significantly associated with thromboprophylaxis, while an inverse correlation was observed with concomitant anti-platelet drugs and platelet count < 70,000/mm³. Patients with a Padua Prediction Score ≥ 4 versus < 4 and with an IMPROVE bleeding score ≥ 7 versus < 7 more frequently received prophylaxis at discharge (31.2% vs. 10.6%, p < 0.0001, and 25.7% vs. 19.6%, p = 0.028, respectively).

Conclusion In this study, one in five patients discharged from an Italian IMU received prophylaxis for VTE. The perceived thrombotic risk is significantly related to the use of prophylaxis.

Keywords

prophylaxis for venous thromboembolism - Internal Medicine Units - post-discharge prophylaxis - predictors

Authors' Contributions

A.S., G.A., E.B., M.C., F.D., A.F., G.G. and A.V. defined the study design. A.S., G.G. and A.V. prepared the case report form. E.B., G.G. and A.V. performed data management and statistical analyses. A.S., G.A., F.A., M.C., F.D., A.F., A.F., A.G., C.N., G.T. and F.V. actively contributed to enrolment of patients. A.S., A.G., G.G. and A.V. wrote the paper. All authors reviewed the paper and agreed to submit it to Thrombosis and Haemostasis.

^* See Supplementary Appendix A (available in the online version) for the list of Sites and Investigators.

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