In the process of every admission , Epic requires the admitting provider to select the method of venous thromboembolism (VTE) prophylaxis or a contraindication before the orders can be signed. Further, VTE prophylaxis is on many of our admission checklists as topics that must be addressed prior to completing the admission. However, in these low-risk patients, is universal VTE prophylaxis necessary?
A recent publication in the Journal of Hospital Medicine addresses this.
Summary:
- While inpatient VTE including deep vein thrombosis (DVT) and pulmonary embolism (PE) cause significant in-hospital mortality (estimated at 5-10% of in-hospital death, these data come from analysis of patients at high risk of VTE.
- Further, studies may overstate the benefit of universal VTE prophylaxis given that many used asymptomatic VTE discovered on ultrasound or venography as a significant portion of the composite outcome.
- The use of VTE poses risks to the patient as well including bleeding/hemorrhage, heparin-induced thrombocytopenia, and, most commonly, injection site discomfort/pain.
- Consider the use of Risk Assessment Models (Table) to aid in the stratification of VTE risk. In patients who are at low risk of VTE, consider listing their contraindication to VTE prophylaxis as “low risk for VTE” when flagged by Epic.
- Encourage early mobilization further reduce VTE risk.
Barlow, B. , Barlow, A. & Breu, A. C. (2021). Things We Do for No Reason™. Journal of Hospital Medicine, 16 (5), 301-303. doi: 10.12788/jhm.3502.