Evaluation of Timing of Pharmacologic Venous Thromboembolism Prophylaxis Initiation in Trauma Patients at a Level One Trauma Center.

IF 0.8 Q4 PHARMACOLOGY & PHARMACY Hospital Pharmacy Pub Date : 2024-10-15 DOI:10.1177/00185787241289289
Taylor A Holder, Cory B McGinnis, Abby L Chiappelli
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Abstract

Background: Major trauma is a risk factor for venous thromboembolism (VTE). Trauma guidelines recommend prompt initiation of pharmacologic VTE prophylaxis. While early initiation is recommended, delays in therapy can occur. Objective: The aim of this study was to evaluate the compliance of pharmacologic VTE prophylaxis initiation timing with trauma guidelines and impact on rates of VTE, bleeding and in-hospital mortality. Methods: This retrospective cohort study included patients admitted to a trauma unit between January 1, 2020 and December 1, 2021. Patients were stratified by injury type and categorized as either compliant or non-compliant based on timing of initiation. Rates of VTE, bleeding, and in-hospital mortality were collected. Results: Of the 300 patients, 259 (86.3%) were compliant. Reasons for non-compliance included bleeding (19.5%) and pending evaluation for intervention such as nerve block procedure (12.2%) and surgical operation (4.9%). There were no differences in VTE (4.8% vs 1.2%, P = .139) or bleeding (4.6% vs 0%, P = N/A) between groups. There was a higher rate of in-hospital mortality in the non-compliant group (12.2% vs 2.3%, P = .009). Upon multivariate logistic regression, the ICU setting was identified as a risk factor for noncompliance (P = .020, OR = .45). Conclusion: Initiating pharmacologic VTE prophylaxis in concordance with trauma guidelines led to low observed rates of VTE and bleeding. In evaluating reasons for noncompliance, we identified areas of improvement for initiation including minimizing inappropriate delays in therapy.

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评估一级创伤中心创伤患者开始静脉血栓栓塞预防药物治疗的时机。
背景:重大创伤是静脉血栓栓塞症(VTE)的一个危险因素。创伤指南建议及时启动药物性 VTE 预防。虽然建议尽早开始治疗,但也可能出现治疗延误。研究目的本研究旨在评估药物预防 VTE 的启动时间是否符合创伤指南,以及对 VTE 发生率、出血率和院内死亡率的影响。研究方法:这项回顾性队列研究纳入了 2020 年 1 月 1 日至 2021 年 12 月 1 日期间入住创伤科的患者。根据受伤类型对患者进行分层,并根据开始治疗的时间将患者分为合规和不合规两类。收集了 VTE 发生率、出血率和院内死亡率。结果:在 300 名患者中,259 人(86.3%)符合要求。未遵医嘱的原因包括出血(19.5%)和等待干预评估,如神经阻滞术(12.2%)和外科手术(4.9%)。VTE(4.8% vs 1.2%,P = .139)或出血(4.6% vs 0%,P = N/A)在各组间无差异。违规组的院内死亡率更高(12.2% vs 2.3%,P = .009)。多变量逻辑回归结果显示,重症监护室环境是导致不达标的风险因素(P = .020,OR = .45)。结论根据创伤指南启动 VTE 药物预防可降低 VTE 和出血的发生率。在评估未遵医嘱的原因时,我们发现了需要改进的地方,包括尽量减少不适当的治疗延迟。
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来源期刊
Hospital Pharmacy
Hospital Pharmacy PHARMACOLOGY & PHARMACY-
CiteScore
1.70
自引率
0.00%
发文量
63
期刊介绍: Hospital Pharmacy is a monthly peer-reviewed journal that is read by pharmacists and other providers practicing in the inpatient and outpatient setting within hospitals, long-term care facilities, home care, and other health-system settings The Hospital Pharmacy Assistant Editor, Michael R. Cohen, RPh, MS, DSc, FASHP, is author of a Medication Error Report Analysis and founder of The Institute for Safe Medication Practices (ISMP), a nonprofit organization that provides education about adverse drug events and their prevention.
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