Thromboprophylaxis assessment in an internal medicine department

There is a lack for French official guidelines for prophylaxis of venous thromboembolism. Therefore an internal referential based on MEDENOX study inclusion criteria was proposed in our internal medicine department. The main goal of this study was to assess the appropriateness of thromboprophylaxis prescriptions regarding the internal referential. A retrospective and observational study included all the patients older than 18 years hospitalized in February and July 2007 in our internal medicine department for at least 48 hours and receiving no anticoagulant treatment. For each patient the following criteria were recorded: admission diagnosis, past medical history, current treatment, creatinine clearance, duration of hospitalisation, thromboprophylactic treatment and course during hospital stay. Eighty-nine patients were included. Forty-two (47.2%) patients had a thromboprophylaxis indication. Among them 40 (95.2%) actually received a thromboprophylaxis. Ten of the 47 patients (21.2%) without thromboprophylaxis indication also received a thromboprophylaxis. The most frequent indications for thromboprophylaxis were an infectious disease with an age greater than 75 years old and a cardiac failure stage III or IV of the NYHA. Most of the studies concerning medical thromboprophylaxis highlight its underutilization in the absence of a referential. In our study the referential use increased the percentage of patients with appropriate thromboprophylaxis but was associated with over-prescriptions in 21.2% of the cases. The use of electronic alerts may increase the number of patients receiving the appropriate treatment.