# Venous thromboembolism prophylaxis in postacute care units: a health record review

## TL;DR

The study examines how often blood clots are prevented in postacute care units and finds that while many patients receive anticoagulants, there's not enough data to determine if they're effective.

## Contribution

The study provides insights into VTE prophylaxis use in postacute care units and highlights the lack of evidence for its effectiveness in this setting.

## Key findings

- 72% of patients in postacute care units received VTE prophylaxis, mostly enoxaparin or unfractionated heparin.
- Thrombotic and bleeding events were rare, making it difficult to assess the risk-benefit balance of VTE prophylaxis.
- VTE prophylaxis recipients were more likely to have recent surgery or active cancer compared to non-recipients.

## Abstract

Venous thromboembolism (VTE), encompassing deep vein thrombosis (DVT) and pulmonary embolism (PE), is a major cause of vascular-related mortality. While VTE prophylaxis (VTEp) is well established in acute care settings, its value in postacute care units, such as transitional care units (TCUs) at our institution, remains unclear.

This study therefore aimed to characterize current VTEp use in TCUs at a tertiary care hospital and to evaluate associated thrombotic and hemorrhagic outcomes.

We conducted a retrospective electronic health record review of patients admitted to TCUs at The Ottawa Hospital between March 1, 2021, and March 1, 2022. Patients on therapeutic anticoagulation for indications other than VTEp or with repeat TCU admissions were excluded. Data were collected with standardized forms and analyzed descriptively; logistic regression was used to explore associations between VTEp and thrombotic or hemorrhagic complications.

Among 1218 patients (mean age, 76 years; 56% female), 72% received VTEp during their TCU stay—primarily enoxaparin (85%) or unfractionated heparin (12%); 75% of these patients remained on prophylaxis for their entire TCU admission. VTEp recipients more often had recent surgery or active cancer, whereas patients in the non-VTEp group more commonly had dementia or previous gastrointestinal bleeding. The overall PE incidence and DVT incidence within 90 days were low (0.8% and 0.9%, respectively) and similar between the groups. Hemorrhagic complications, intracranial hemorrhage (0.4%), and gastrointestinal bleeding (0.9%) were likewise infrequent and comparable. Adjusted odds ratios for these outcomes included 1.0 with wide CIs.

VTEp was used frequently and was usually continued for the full TCU stay. The number of VTE and bleeding events were low, limiting the ability to determine the optimal risk-benefit balance of VTEp use in this population.

•Little is known about the practice patterns and effectiveness of anticoagulants used to prevent venous thromboembolism (eg, pulmonary embolism and deep vein thrombosis) during the immediate postacute care period, when patients remain in the hospital after their acute medical needs have been addressed.•We conducted a health record review at a tertiary care hospital in Canada.•We found that the majority of patients in this population received venous thromboembolism prophylaxis, often continued for the duration of their stay in postacute care units.•Thrombotic and bleeding events were rare; as a result, we could not determine whether anticoagulant use in this context reduces or increases these outcomes.

Little is known about the practice patterns and effectiveness of anticoagulants used to prevent venous thromboembolism (eg, pulmonary embolism and deep vein thrombosis) during the immediate postacute care period, when patients remain in the hospital after their acute medical needs have been addressed.

We conducted a health record review at a tertiary care hospital in Canada.

We found that the majority of patients in this population received venous thromboembolism prophylaxis, often continued for the duration of their stay in postacute care units.

Thrombotic and bleeding events were rare; as a result, we could not determine whether anticoagulant use in this context reduces or increases these outcomes.