June 26, 2013
Overcoming Resistance to VTE Prophylaxis in
Hospitalized Patients

Baltimore, MD—Patients are receiving fewer than 90% of the blood-thinner doses ordered by their doctors, according to a new study that suggests misguided concerns by patients and their caregivers could be to blame.

In the study, published recently in the online, peer-reviewed journal PLOS ONE, the Johns Hopkins University researchers call the rate of missed doses “unacceptably high,” adding that hospitalized patients are at a significantly greater risk of developing venous thromboembolism (VTE).

“There appeared to be a lack of understanding about the risks and benefits of blood thinners among patients and medical staff, even though the research is clear that blood thinners are very effective at preventing blood clots,” said lead author Kenneth M. Shermock, PharmD, PhD, director of Johns Hopkins Hospital’s Center for Medication Quality and Outcomes at The Johns Hopkins Hospital. “Blood clots and their resulting effects are the most common cause of avoidable death for hospitalized patients and we've got a medication that can prevent most of these events. But too many patients are not benefitting.”

About 12% of ordered doses were not administered to patients, with family refusal (59%) being the most common reason. Another issue was that patients sometimes were away from their rooms for surgery or testing when the medication was scheduled to be administered.

Shermock also pointed out past research suggesting that nurses may have implied to patients that blood thinners are optional and called for more targeted education for hospital staff.

For the study, researchers analyzed more than 103,000 VTE prophylaxis doses of unfractionated heparin or enoxaparin ordered for more than 10,500 patients at The Johns Hopkins Hospital between December 1, 2007, and June 30, 2008. Included in the analysis were patients from 29 floors: 11 medicine floors, nine surgery floors, four neurology floors, and five intensive care units.

While the average rate of noncompliance was 12%, researchers found much lower compliance rates in some areas compared to others. The worst were on two medicine floors where 25% to 30% of blood-thinner doses were not administered.

The authors noted that a majority of patients get most of their prescribed doses, which are given at 8-, 12-, or 24-hour intervals, with nearly 60% getting all of them. About 20% of patients accounted for 80% of missed doses, with 20% of those missing at least a quarter of their doses and 10% missing more than half of their doses.

Shermock suggested that focusing specifically on those patients who have missed doses could result in a big impact on compliance, suggesting that the electronic medical record could be used to show which patients have refused their medication and allow immediate intervention.

“We want to be able to get to these patients before there is an adverse event,” he said.

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