Background: Venous thromboembolism (VTE) is a common complication of hospital admission. The VTE mortality rate in Ireland is approximately 4,000 per year, 48% of which are deemed preventable [1][2]. In 2008, University Hospital Limerick (UHL) conducted an audit showing inadequate thromboprophylaxis among medical patients. A medical proforma was subsequently introduced with a dedicated thromboprophylaxis prompt and follow up audits in 2012, 2015, 2018. This increased prophylaxis rates by 39% in high-risk patients by 2015.

Aims: This study aims to assess current practise of thromboprophylaxis among acutely ill patients to demonstrate the potential efficacy of implementing VTE prompts into standard admission policies.

Methods: A cross-sectional study was conducted in UHL and Nenagh hospital (NGH) from September to November 2019. Exclusion criteria included patients on therapeutic anticoagulation or those with anticoagulation contraindications. Risk was calculated using the Padua Score.[3] Anticoagulation prescriptions from medication lists were then recorded.

Results: Two-hundred and forty-three patients (193 UHL, 50 NGH) were identified. One-hundred and eight-two were included after exclusion criteria. In UHL, the medical proforma was used in all patients. Seventy-three (50.7%) thromboprophylaxis prompts were completed compared with 25% in 2018. Twenty-one patients were low risk, forty-seven moderate risk and seventy-six were high risk. Of low-moderate risk patients and high risk patients 60.3% and 76% received thromboprophylaxis respectively. This was a statistically significant increase in the high risk group from 63% in 2018 (p=0.071). Overall thromboprophylaxis rates were significantly higher than in 2008 (10% in low-moderate risk, 24% in high risk). Thromboprophylaxis rates in NGH were 76% in low-moderate risk and 80% in high risk patients.

Conclusions: VTE is a preventable life-threatening condition. Completion of the thromboprophylaxis proforma increased thromboprophylaxis rates in this group of high risk patients. Implementation of VTE prompts can therefore contribute to optimisation of VTE prevention strategies. This vital to reduce patient exposure to potentially devastating outcomes.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/vte-prophylaxis-performance-in-a-tertiary-and-secondary-level-hospital-in-ireland/