Learning Objective: Audience members will be able to identify patients who are appropriate to receive venous thromboembolism (VTE) prophylaxis.
Self Assessment Question: At the conclusion of my presentation, the participant will be able to recognize appropriate prescribing of VTE prophylaxis.
Background/Objective: The purpose of this study was to identify the appropriate usage of VTE prophylaxis in the inpatient setting. Guidelines for VTE prophylaxis refer to the IMPROVE VTE and Bleed scores as a method of risk assessment before starting.
Methods: This retrospective chart review included patients >18 years admitted in three medical floors, medical, and cardiac ICU, who received VTE prophylaxis between July 1 and August 8, 2025. The exclusion criteria included admissions for bleeds, pregnant and postpartum patients, repeat admissions, and therapeutic anticoagulation orders. The primary objective was the percentage of inappropriate VTE prophylaxis prescribing, based on IMPROVE VTE and IMPROVE Bleed scores. Secondary outcomes include bleeding 48 hours after last dose of prophylaxis given, the percentage of patients ineligible based on their IMPROVE VTE score, percentage of patients ineligible based on their IMPROVE Bleed score, and percentage of appropriate VTE prophylaxis prescribing in the ICU compared to non-ICU settings.
Results: A total of 248 patients met the inclusion criteria, and 64 patients were excluded, leading to a total of 184 patients being studied. The primary objective revealed that 69% of total included patients had inappropriately received VTE prophylaxis based on their IMPROVE scores. Looking at the secondary outcomes, 3 patients experienced a bleed. 2 of these patients were ineligible to receive prophylaxis, while 1 was eligible. 67% of patients deemed ineligible for VTE prophylaxis did not meet criteria to start due to a low IMPROVE VTE score. Overall, percentages of ineligible and eligible patients were similar between ICU and non-ICU patients..
Conclusion: Application of the IMPROVE VTE and Bleeding risk scores to assess appropriateness for VTE prophylaxis suggests that prophylaxis may be overprescribed in the inpatient setting, including both ICU and non-ICU populations. Pharmacists in different practice areas should continuously evaluate a patient’s risk of VTE and bleeding to potentially deescalate prophylactic prescribing, which could improve patient satisfaction and cost savings.
