PMID- 17032931 OWN - NLM STAT- MEDLINE DCOM- 20070612 LR - 20220321 IS - 1079-2082 (Print) IS - 1079-2082 (Linking) VI - 63 IP - 20 Suppl 6 DP - 2006 Oct 15 TI - Thromboprophylaxis in medically ill patients at risk for venous thromboembolism. PG - S23-9 AB - PURPOSE: According to guidelines from the American College of Chest Physicians, low-molecular-weight heparin (LMWH) and unfractionated heparin (UFH) should be prescribed to medical (nonsurgical) patients at high risk of venous thromboembolism. Thromboprophylaxis and mortality rates were determined in medical inpatients with indications for thromboprophylaxis. Cost differences between patient groups were investigated and are discussed. SUMMARY: Using Solucient's ACTracker Inpatient Database, medical discharges between January 2001 and December 2004 were extracted and patients who had indications for thromboprophylaxis (acute myocardial infarction, ischemic stroke, cancer, heart failure, or severe lung disease) were identified. Patients < 40 years or with deep-vein thrombosis or pulmonary embolism, active peptic ulcer, malignant hypertension, blood disease, HIV infection, or intubation of gastrointestinal or respiratory tract were excluded. Rates of thromboprophylaxis and mortality were compared between groups. Mean total drug costs and hospital costs per patient discharge were compared between patient groups. Of 12,887,080 medical discharges extracted from 330 hospitals, there were 2,367,362 patients with indications for thromboprophylaxis. Patients were subdivided on the basis of whether they received thromboprophylaxis (n = 717,850) or not (n = 1,649,512). The thromboprophylaxis rate was low, despite increasing from 26% to 33% over the study period. Patients receiving thromboprophylaxis had significantly lower risk-adjusted mortality rates than those who did not (p < 0.001), except those with ischemic stroke. The mean total drug cost per patient receiving LMWH and UFH ($791 and $569, respectively) was higher than for patients not receiving thromboprophylaxis ($372) (p < 0.001). The mean total hospital cost per patient receiving UFH ($7615) was higher than for LMWH ($6866, p < 0.001). CONCLUSION: The thromboprophylaxis rate among medical patients was low, with no significant improvement between 2001 and 2004. Thromboprophylaxis can impact patient mortality rates. Economic evaluation revealed that the use of LMWH for thromboprophylaxis in at-risk medical patients was associated with higher total drug costs but lower total hospital costs than UFH. Efforts should be made to increase clinicians' awareness of clinical guidelines. FAU - Burleigh, Edward AU - Burleigh E AD - Solucient Inc., Evanston, IL, USA. FAU - Wang, Cheng AU - Wang C FAU - Foster, David AU - Foster D FAU - Heller, Sivana AU - Heller S FAU - Dunn, Dennis AU - Dunn D FAU - Safavi, Kaveh AU - Safavi K FAU - Griffin, Brian AU - Griffin B FAU - Smith, Jeff AU - Smith J LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - England TA - Am J Health Syst Pharm JT - American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists JID - 9503023 RN - 0 (Heparin, Low-Molecular-Weight) SB - IM MH - Data Interpretation, Statistical MH - Databases, Factual/statistics & numerical data MH - Drug Costs MH - Female MH - Heart Failure/complications MH - Heparin, Low-Molecular-Weight/economics/*therapeutic use MH - Hospital Costs/statistics & numerical data MH - Hospital Mortality MH - Humans MH - Inpatients/*statistics & numerical data MH - Intensive Care Units/economics MH - Length of Stay/economics MH - Male MH - Myocardial Infarction/complications MH - Neoplasms/complications MH - Patient Discharge/economics MH - Risk Factors MH - Stroke/complications MH - Thromboembolism/etiology/mortality/*prevention & control MH - Time Factors EDAT- 2006/10/13 09:00 MHDA- 2007/06/15 09:00 CRDT- 2006/10/13 09:00 PHST- 2006/10/13 09:00 [pubmed] PHST- 2007/06/15 09:00 [medline] PHST- 2006/10/13 09:00 [entrez] AID - 63/20_Supplement_6/S23 [pii] AID - 10.2146/ajhp060390 [doi] PST - ppublish SO - Am J Health Syst Pharm. 2006 Oct 15;63(20 Suppl 6):S23-9. doi: 10.2146/ajhp060390.