70% of patients
The use of a risk stratification protocol allowed the avoidance of more aggressive anticoagulation in 70% of patients
while achieving a low overall incidence of VTE.
The stats are in! How to reduce your patient’s risk for bleeding.
Featured expert
William Nadeau, MS, RD
Medical Affairs Director, Cardinal Health
The challenges with Hospital-Associated Venous Thromboembolism (HA-VTE)
Despite its classification by Centers for Medicare & Medicaid Services as a never event in 2018, today HA-VTE remains a persistent and preventable, condition in the United States.
Though anticoagulants have been traditionally considered the recommended form of VTE prevention, anticoagulant therapy for VTE prevention is associated with additional risk for bleeding events.
By assigning patients at lower risk for VTE or higher risk for bleeding to alternative thromboprevention, such as early ambulation, intermittent pneumatic compression (IPC) and aspirin, via risk stratification, healthcare providers may maintain a low overall incidence of VTE while limiting patient exposure to bleeding risk.
Evidence for ability to potentially limit patient exposure to bleeding risk
By assigning patients at lower risk for VTE or higher risk for bleeding to alternative thromboprevention, such as early mobilization, IPC and aspirin; healthcare providers may maintain a low overall incidence of VTE while limiting patient exposure to bleeding risk.
In one study, the use of a risk stratification protocol allowed the avoidance of more aggressive anticoagulation in 70% of patients while achieving a low overall incidence of VTE.
*After two years of patient enrollment, the following inclusion criteria were removed as a result of encouraging results in a preliminary analysis: age>70 years, multiple medical comorbidities, and morbid obesity.
- A prospective, non-inferiority study in 3143 patients
- Undergoing unilateral total hip or knee arthoplasty
- Underwent a risk stratification protocol assigning patients to high risk or routine VTE prevention
The use of aspirin and IPC in a risk-stratified total joint arthroplasty population is a safe and cost-effective method of VTE prevention.
There was a significant reduction of total hospital costs by 18.15% for patients receiving IPC and aspirin.
- Performed a retrospective study in 2611 patients
- Compared VTE rates and bleeding rates in a historical routine anticoagulant cohort
- Risk stratified cohort that assigned patients to IPC and aspirin or anticoagulant therapy according to VTE risk
- Two groups were equivalent for VTE prevention
Adequate VTE prevention could be achieved using a combination of IPC devices, early ambulation, emphasis on hydration, and shorter operating times. Bariatric surgery can be safely performed without pharmacologic VTE prevention in all but the high-risk population. Fewer bleeding complications occur without the use of anticoagulants.
Fewer bleeding complications occur without the use of anticoagulants with bariatric patients.
- In a single center study, VTE rates were compared before and after the implementation of a risk stratification protocol for 1,692 patients undergoing bariatric surgery
- Before implementation, patients received postoperative enoxaparin along with IPC
- After implementation, low-risk patients received IPC with hydration and ambulation
- After implementation, High-risk patients received enoxaparin along with IPC
- Differences in the incidence of DVT, PE, and intraluminal bleeding rates were all statistically significant. Mortality was not statistically significant.
