Venous thromboembolism (VTE) presents as deep venous thromboembolism (DVT) or pulmonary embolism (PE). VTE is the third most common vascular disease and a leading cardiovascular complication.1,2 Hospitalized patients are at increased risk of developing VTE due to multiple factors such as inflammatory processes from acute illness, recent surgery or trauma leading to hypercoagulable states, and prolonged periods of immobilization.3 Additional risk factors for complications include presence of malignancy, obesity, and prior history of VTE. About half of VTE cases in the community setting occur as a result of a hospital admission for recent or ongoing acute illness or surgery.1 Hospitalized patients are often categorized as high risk for VTE, and this risk may persist postdischarge.4
The risk of hospital-associated VTE may be mitigated with either mechanical or pharmacologic thromboprophylaxis.5 Risk assessment models (RAMs), such as Padua Prediction Score (PPS) and IMPROVEDD, have been developed to assist in evaluating hospitalized patients’ risk of VTE and need for pharmacologic thromboprophylaxis (Table 1).1,5 The PPS is externally validated and can assist clinicians in VTE risk assessment when integrated into clinical decision making.6 Patients with a PPS ≥ 4 are deemed high risk for VTE, and pharmacologic thromboprophylaxis is indicated as long as the patient is not at high risk for bleeding. IMPROVEDD added D-dimer as an additional risk factor to IMPROVE and was validated in 2017 to help predict the risk of symptomatic VTE in acutely ill patients hospitalized for up to 77 days.7 IMPROVEDD scores ≥ 2 identify patients at high risk for symptomatic VTE through 77 days hospitalization, while scores ≥ 4 identify patients who may qualify for extended thromboprophylaxis.7 Despite their utility, RAMs may not be used appropriately within clinical practice, and whether patients should receive extended-duration thromboprophylaxis postdischarge and for how long is debatable.5
VTE events contribute to increased health care spending, morbidity, and mortality, thus it is imperative to evaluate current hospital practices with respect to appropriate prescribing of pharmacologic thromboprophylaxis.8 Appropriately identifying high-risk patients and prescribing pharmacologic thromboprophylaxis to limit preventable VTEs is essential. Conversely, it is important to withhold pharmacologic thromboprophylaxis from those deemed low risk to limit bleeding complications.9 Health care professionals must be good stewards of anticoagulant prescribing when implementing these tools along with clinical knowledge to weigh the risks vs benefits to promote medication safety and prevent further complications.10This quality improvement project aimed to evaluate if VTE thromboprophylaxis was appropriately given or withheld in hospitalized medical patients based on PPS calculated upon admission using a link to an online calculator embedded within an admission order set. Additionally, this study aimed to characterize patients readmitted for VTE within 45 days postdischarge to generate hypotheses for future stu