Purpose: The purpose of this study is to evaluate current institutional practices related to initiation and dosing of pharmacological venous thromboembolism (VTE) prophylaxis.
Methods: This retrospective, single-center, chart review evaluated 150 patients from January 1-June 30, 2025. Adult patients who received at least 48 hours of pharmacologic VTE prophylaxis with a length of stay between 3 to 28 days were included. Patients were excluded if they had a clear indication for VTE prophylaxis (recent trauma, surgery, or active malignancy). The primary endpoint is the number of patients appropriately initiated on pharmacologic prophylaxis based on a Padua Prediction Score of ≥4. Secondary endpoints include the number of patients with appropriately dosed thromboprophylaxis based on body weight or BMI, the incidence of adverse events, and the number of readmissions due to bleeding or clotting events. Data included patient characteristics, components of the Padua Prediction and HAS-BLED scores, medication regimens, adverse events, and readmissions. Descriptive analysis was utilized to interpret the data.
Results: Fifty-eight patients (38.7%) with a Padua Prediction score of ≥4 were appropriately initiated on VTE prophylaxis. There were 125 patients (83.3%) initiated on VTE prophylaxis at an appropriate dose for their BMI/body weight. Of patients dosed inappropriately, the highest rate of dosing errors (88.3%) occurred in those with a low BMI/body weight. Adverse events and readmissions related to clotting or bleeding were rare. One DVT (0.7%) and one episode of major bleeding (0.7%) occurred during admission. Two patients had readmissions (1.4%), one related to bleeding, and one related to clotting. Enoxaparin was the agent used the most (56.7%) and had the greatest rate of inappropriate dosing among patients (11.3%).
Conclusion: In patients without a clear indication for VTE prophylaxis, pharmacologic agents are frequently initiated unnecessarily. Patients with a low BMI/body weight demonstrated the highest rate of inappropriate dosing, highlighting the need for improved risk assessment and standardized protocols at our institution. Optimizing the initiation of thromboprophylaxis presents an opportunity to reduce unnecessary medication use and healthcare costs.
Graduated from Temple University School of Pharmacy - Class of 2025 Current Temple University Hospital PGY-1 resident Upcoming PGY-2 Critical Care resident at Penn Presbyterian Hospital
