Background: Venous thromboembolism (VTE) poses a significant risk to patients in the hospital setting, and studies have shown that VTE prophylaxis should be incorporated into the management of high-risk patients during their hospital stay. However, many of these patients are still high-risk for VTE at the time of discharge and for up to three months after discharge. In fact, 50% of VTE events occur approximately 30 days after hospital discharge, with patients often discharged home without any form of VTE prophylaxis.

Aims: To identify a need for change in hospital discharge protocols in order to reduce the incidence of VTE events among non-ICU, medically ill patients hospitalized at our regional medical centers by focusing on extended prophylaxis for patients discharged from our institution.

Methods: This retrospective study utilized data that was collected from 100 patients admitted to our medical service in 2019. Patients who expired during their hospitalization were excluded. The patients were evaluated using three different VTE risk scales to determine their risk for VTE at time of discharge: IMPROVE, Padua, and Geneva.

Results: At the time of hospital discharge, 56% of patients were at high-risk for VTE, indicated by a Padua Score ≥ 4. 78% of patients were at high-risk for VTE based on a Geneva Score ≥ 3 at discharge. Additionally, 24% of patients were at high-risk for VTE at time of discharge with an IMPROVE Score ≥ 3.

Conclusions:

There is a need for continued prophylaxis after discharge, as 24-78% of the patients included in our study were still at high-risk for VTE at the time of discharge, which is an indication for VTE prophylaxis. Based on these results and other recent studies, our recommendation is to implement a new protocol at our institution that requires patients with a high-risk score for VTE to receive extended prophylaxis upon discharge, either with Rivaroxaban or Betrixaban.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/vte-risk-at-discharge/